대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1213 Date 2021-01-19

  • Courtesy of Jin, Kwang Nam / SMG-SNU Boramae Medical Center
  • Age/Sex 74 / M
  • Chief ComplaintChief complaint> Neck pain and vomiting, 10 DA, Underlying disease> None
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Intramural esophageal dissection
Radiologic Findings
Chest radiograph shows air-filled upper esophageal luminal opacity.
CT demonstrates diffuse esophageal wall thickening, luminal dilatation, debris in the lumen, and double-barreled appearance with multiple entry points.
Brief Review
• An esophageal ulcer is a distinct break in the margin of the esophageal mucosa. This mucosal damage to the esophagus is often caused by gastroesophageal reflux disease or from severe sustained esophagitis from other causes. Corrosive or caustic agents and ingested foreign bodies can cause direct esophageal mucosal damage. Infections causing inflammation of the esophagus include Candida species, Herpes simplex, and cytomegalovirus. Prognosis is good in patients who are compliant with their therapy and maintain an appropriate diet. Untreated esophageal ulcerations can lead to bleeding. In this case, intramural esophageal dissection was noted, which is an uncommon disorder characterized by a lengthy laceration deeper to the mucosal layer of the esophageal wall, without complete perforation.
• Intramural dissection can be considered an intermediate form of injury between a Mallory-Weiss tear and transmural perforation. The most common cause is recent instrumentation such as endoscopy or stricture dilatation. The appearance of a dissection flap has been referred to as a “double-barrel esophagus”. The majority of cases respond well to conservative management.
Please refer to
Case 233, Case 935,
References
1) CT Features of Esophageal Emergencies RadioGraphics 2008;28; 6
2) Imaging of esophageal emergencies Applied Radiology 2016
3) Double lumen esophagus: A rare complication of gastroesophageal reflux disease Digestive Endoscopy 2014; 26: 282–284
4) Circumferential intramural esophageal dissection with large mucosal defect Clinical Journal of Gastroenterology 2020; 13;1–3
Keywords
Esophagus, Intramural esophageal dissection,

No. of Applicants : 96

▶ Correct Answer : 33/96,  34.4%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Other , Korea (South) HYEJIN YANG
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Korea (South) PARK JONGMIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KANAE TAKAHASHI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Kyeongpook National University Hospital , Korea (South) PARK BYUNG GEON
  • - Other , Korea (South) KYU-CHONG LEE
  • - Tashkent Medical Academy , Uzbekistan Rustam Azimovich Fayzullaev
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan TOMOKI IMOKAWA
  • - Tokyo Metropolitan Bokutoh Hospital , Japan TOMOKI WADA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Correct Answer as Differential Diagnosis : 11/96,  11.5%
  • - Korea University Guro Hospital , Korea (South) LEE SEOKYOUNG
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Other , Korea (South) MINSU KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - , Japan KAZUMA TERAUCHI
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 3/96,  3.1%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - HHS , Canada S LEE
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
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