대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 822 Date 2013-07-29

  • Courtesy of Jan Hyeon Song / Chonnam National University Hospital
  • Age/Sex 68 / M
  • Chief ComplaintEpigastric pain and fever (onset: 1 day ago), Past history of DM and alcoholic liver cirrhosis
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8
  • Figure 9
  • Figure 10

Diagnosis With Brief Discussion

Diagnosis
Acute Phlegmonous Esophagagogastritis
Radiologic Findings
Initial CT images show diffuse wall thickening and intramural low-density area in whole esophagus and upper stomach. Intramural low-density area is surrounded by peripheral enhancing rim, that is suggestive of intramural abscess.
After 1 week, air bubbles are newly appeared in thickened esophageal wall, which means the intramural abscess spontaneously drained into the esophageal lumen.
Brief Review
Acute phlegmonous esophagitis is uncommon disorder. A bacterial infection occurs in the submucosa and musculature of the esophagus. Phlegmonous infection usually involves the submucosa and not the mucosa. Phlegmonous gastritis is more common than phlegmonous esophagitis and may be either localized or diffuse.
The pathogenesis of acute phlegmonous esophagitis is unclear. Reported predisposing factors include immune suppression, alcoholism, peptic ulcer disease, chronic gastritis or some other gastric mucosal injury, achlorhydria, infection, connective tissue disease, and malignancy. Presumably, these conditions predispose the stomach to infection by eliminating various defense mechanisms, such as, inherent gastric cytoprotection or the bactericidal effect of gastric acid. Nevertheless, approximately 50% of reported cases were previously healthy and had no significant anteceding risk factors.
CT findings of phegmonous esophagitis are esophageal wall thickening and intramural low-density areas. The area of intramural low attenuation surrounded by a peripherally enhancing rim represents intramural abscess. The air bubbles in the thickened esophageal wall seen on CT may be produced by gas-forming organisms (indicating emphysematous esophagogastritis), or the air bubbles may have entered the wall when the intramural abscess spontaneously drained into the lumen.
References
1.Jung C et al. Acute Diffuse Phlegmonous Esophagogastritis: Radiologic Diagnosis. American Journal of Roentgenology. 2003;180:862-863
2. Hsu CY et al. Acute diffuse phlegmonous esophagogastritis: report of a survived case. Hepatogastroenterology 1996; 43:1347-1352
3. Kim HS et al. Acute Diffuse Phlegmonous Esophagogastritis: A Case Report. J Korean Med Sci. 2010; 25(10): 1532
Keywords
Esophagus, stomach, infection, Bacterial infection,

No. of Applicants : 83

▶ Correct Answer : 14/83,  16.9%
  • - Kyoto University , Japan Akihiko Sakata
  • - , Korea (South) Kim sungmo
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Chonnam Nationl University Radiology , Korea (South) juwon kim
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - Korea university , Korea (South) Kun Woo Kang
  • - Soonchunhyang University Seoul Hospital , Korea (South) EUNSUN OH
  • - Hanyang university medical center , Korea (South) Yoonah Song
  • - IRSA La Rochelle , France Denis Chabassiere
  • - University of Ulsan College of Medicine , Korea (South) Joo yeon Lee
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
▶ Correct Answer as Differential Diagnosis : 1/83,  1.2%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
▶ Semi-Correct Answer : 6/83,  7.2%
  • - Tokyo Metropolitan Police Hospital , Japan Akifumi Hagiwara
  • - King fahed hospital in hofuf , Saudi Arabia jaafer Al-obaid
  • - University of British Columbia , Canada Amr Ajlan
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - SKG radiology , Australia Yuranga Weerakkody
  • - All India Institute of medical sciences , India Justin Moses
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

This website is optimized for IE 10 and above.