Esophageal entrapment with blunt thoracic spinal trauma
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CASE REPORT
Esophageal entrapment with blunt thoracic spinal trauma R. Steven DeLappe Jr & Surjith Vattoth & Sushilkumar K. Sonavane
Received: 19 September 2012 / Accepted: 8 October 2012 / Published online: 16 October 2012 # Am Soc Emergency Radiol 2012
Abstract Esophageal injury due to blunt trauma rarely occurs. However, prompt diagnosis and treatment of such injury is essential to improve patient survival. We report an extremely rare case of esophageal entrapment within a hyperextension fracture dislocation of the thoracic spine, which was diagnosed by reviewing an esophagram and CT image simultaneously. Esophageal injury should be considered with thoracic spine trauma, especially if the T3/4 level is involved.
dysphagia and subsequent feeding tube advancement through the esophagus was unsuccessful. In both of the previously reported cases, the site of esophageal entrapment was also at the T3/4 level, where the esophagus is anatomically very close to the spine [5]. In a patient with dysphagia following spine trauma, it is important to look for signs of esophageal entrapment within a thoracic spine fracture with the aid of oral water-soluble contrast medium when evaluating the spine CT scan.
Keywords Esophagus . Entrapment . Thoracic spine . Hyperextension . Fracture . T3/4 Case report Introduction Esophageal trauma typically results from penetrating or iatrogenic factors with blunt traumatic injuries being a rare cause [1, 2]. Early recognition and treatment of esophageal injuries significantly improves patient survival, but the diagnosis can often be delayed [3]. Esophageal entrapment within a thoracic spine fracture is extremely rare with only two cases reported in the literature [2, 4]. We report a case of proximal esophageal entrapment and obstruction from a T3/4 hyperextension fracture–dislocation that was subsequently relieved by surgical fixation and release of the esophagus. Esophageal entrapment was diagnosed through esophagram and chest CT scan a few days after the initial trauma, when the patient complained of R. S. DeLappe Jr (*) : S. Vattoth : S. K. Sonavane Department of Radiology, University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249-6830, USA e-mail: [email protected]
A 67-year-old female with end stage renal disease, diabetes, and hypertension fell down the stairs and was discharged from an outside facility with the impression of no significant injury. She then presented to our emergency department four days later with persistent headache and neck pain. The patient did not have any significant neurological deficits on physical examination. A cervical spine CT scan demonstrated a burst fracture at C5 (Fig. 1). The initial chest radiograph demonstrated no significant thoracic injury. A thoracic spine radiograph was interpreted as limited due to positioning with no gross fracture or malalignment. Prior to cervical spine surgery, enteric feeding tube placement was attempted on the floor unsuccessfully with repeated coiling of the tube. The patient was subsequently referr
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