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Weekly Chest CasesArchive of Old Cases

Case No : 935 Date 2015-09-28

  • Courtesy of Eenyoung Cho, Kyung Won Doo, Jong Woon Song / Haeundae Paik hospital
  • Age/Sex 45 / M
  • Chief ComplaintRetrosternal and neck area pain with vomiting for 5 days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Intramural esophageal dissection
Radiologic Findings
Contrast enhanced axial CT scan shows double lumen configuration of the esophagus separated by mucosal layer, diffuse esophageal wall thickening, and fluid retention in false lumen of the esophagus. Mild mediastinal fat infiltration is noted. Focal mucosal defect is suspected in upper esophagus. Double lumen appearance of the esophagus is also shown on esophagography.
Brief Review
Intramural esophageal dissection is a rare condition characterized by a mucosal tear and following intramural extension lead to separation of the mucosal and/or submucosal layer from the esophageal wall, with or without perforation. Patients usually present with acute chest pain, odynophagia, dysphagia and hematemesis. The pathogenesis remained unknown, however, subsequent traumatic break in mucosa and elevation of intraesophageal pressure might be the one. An esophageal contrast study may show typical double-barrelled esophagus, contrast filled in true and false lumen of the esophagus separated by mucosal layer (mucosal stripe sign). The false lumen appears as well-defined tubular structure with blind end, which may be larger than the true lumen. A thin hypodense mucosal flap dividing true and false lumen, intramural air bubbles and hyperdense esophageal wall (intramural hematoma) are reported as CT features of esophageal dissection. The site of mucosal tear could be revealed on endoscopy. There are three options for management of the intramural esophageal dissection, conservative therapy, endoscopic interventions and surgery.
Please refer to
Case 233,
References
1. Khil EK, Lee H, Her K. Spontaneous intramural full-length dissection of esophagus treated with surgical intervention : multidetector CT diagnosis with multiplanar reformations and virtual endoscopic display. KJR 2014;15(1):173-177
2. Krishnam MS, Ramadan MF, Curtis J. Intramural esophageal dissection : CT imaging features. EJR Extra 2005;56:17-19
3. Heitmiller RF. Intramural esophageal dissection with perforation. Gastroenterology&hepatology 2008;4:365-366
Keywords
Esophagus, Trauma,

No. of Applicants : 95

▶ Correct Answer : 48/95,  50.5%
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - university of montreal , Canada Andrei Gorgos I
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Himeji Redcross Hospital , Japan Soichiro Okamoto
  • - radiologist, aditya imaging centre , India vivek patel
  • - Tashkent Medical Academy , Uzbekistan Rustam Fayzullaev
  • - Kyoto University , Japan Akihiko Sakata
  • - Hanam sungshim hospital , Korea (South) CHANG IL KIM
  • - chp st martin , France Mariotte benoit
  • - Niigata University , Japan Atsushi Uehara
  • - Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
  • - Kosin University Gospel Hospital , Korea (South) Hee Kang
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - privato , Italy genchi enzo
  • - McGill University Health Center , Canada Alexandre Semionov
  • - University of British Columbia , Canada Amr Ajlan
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - GHICL , France manuel toledano
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - VHS medical center , Korea (South) Keuntak Roh
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - Pusan national university hospital , Korea (South) So Park
  • - Hanyang universitiy, radiology department , Korea (South) HyunGyu Lee
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - 異⑸ , Korea (South) Yunhee Jang
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - IRSA La Rochelle , France Denis Chabassiere
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - Asan , Korea (South) Sania ALBlushi
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - CNUH , Korea (South) Noh Hoon
  • - Gifu Central Hospital , Japan Haruo Watanabe
▶ Correct Answer as Differential Diagnosis : 11/95,  11.6%
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Kyungpook national university hospital , Korea (South) Nari Jung
  • - Chonnam Nationl University Radiology , Korea (South) Ju Won Kim
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - CHU Poitiers , France CHAN paul
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Chonnam national university hospital , Korea (South) Lee Yubin
  • - Chonnam national university hospital , Korea (South) Jong-hyeon Kim
  • - CNUH , Korea (South) LEE HYO JAE
  • - Medicheck health care , Korea (South) Chae Lim
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
▶ Semi-Correct Answer : 3/95,  3.2%
  • - Goa Medical College , India Paresh Desai
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
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