대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1160 Date 2020-01-20

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  • Courtesy of Da Som Kim / Seoul National University Hospital
  • Age/Sex 52 / F
  • Chief ComplaintEpigastric pain (4 days ago) / DM without medication
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Acute phlegmonous esophagitis
Radiologic Findings
Figs 1. Chest CT scan shows diffuse edematous circumferential wall thickening of the esophagus with intramural low density area. Intramural low attenuation is surrounded by peripheral enhancing rim.
Figs 2. After 2 weeks, CT reveals mucosal defect and flap at the esophagus, which suggests intramural dissection.
Fig 3. Gastrograffin esophagography after 2 weeks reveals double lumen feature of the entire esophagus and blind end of the posterior wall side lumen, possible false 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 infection may involve any gastrointestinal tract site, although the stomach is most frequently involved.
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.
The reported 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.
Please refer to
Case 822, Case 1074,
References
1.Jung C et al. Acute Diffuse Phlegmonous Esophagogastritis: Radiologic Diagnosis. American Journal of Roentgenology. 2003;180:862-863
2. Kim HS et al. Acute Diffuse Phlegmonous Esophagogastritis: A Case Report. J Korean Med Sci. 2010; 25(10): 1532
Keywords
esophagus, esophagitis, phlegmonous esophagitis,

No. of Applicants : 78

▶ Correct Answer : 40/78,  51.3%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Lille , France BENOIST CAPON
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - Kyeongpook National University Hospital , Korea (South) CHANGGUN KIM
  • - , Korea (South) CHOHEE KIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The Jikei university , Japan TAKU GOMI
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - Other , Korea (South) HONG SANG HYUP
  • - , Korea (South) PARK JONGMIN
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Other , Korea (South) JUWON KIM
  • - Chungbuk National University Hospital , Korea (South) YOUNGHUN JEON
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
  • - TB centre kasaragod. , India rikhy krishnan
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - , Korea (South) JIHYUN KIM
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul National University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 4/78,  5.1%
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Toranomon Hospital , Japan KAORU SUMIDA
▶ Semi-Correct Answer : 8/78,  10.3%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
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