Esophageal pneumatosis: a pictorial review
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PICTORIAL ESSAY
Esophageal pneumatosis: a pictorial review Emily R. Neal 1
&
Rakesh Jha 2
Received: 25 March 2020 / Accepted: 13 April 2020 # American Society of Emergency Radiology 2020
Abstract Gastrointestinal pneumatosis has been reported from the esophagus to the rectum, with most cases involving the small bowel, stomach, or colon. Esophageal pneumatosis is rare, with only a small number of case reports described in the literature, although it is likely underreported. Esophageal pneumatosis may be idiopathic or secondary to a specific underlying cause. Mechanisms of esophageal pneumatosis include increased intraluminal pressure, mucosal disruption, and dissection of air from an extraesophageal source. Depending on the underlying cause, esophageal pneumatosis is usually benign although it may be indicative of a life threatening condition. Esophageal pneumatosis is typically detected with CT, although it may be evident during direct visualization with endoscopy. In this article, we review the etiologies and imaging appearances of esophageal pneumatosis. Keywords Esophagus . Pneumatosis . Emphysema . Pneumomediastinum
Introduction Pneumatosis is defined as the presence of air or gas in abnormal places within the body. When pneumatosis involves the wall of the gastrointestinal tract, it typically is located within the small bowel, stomach, or colon. Esophageal pneumatosis is rare, with only a small number of cases described in the world literature, although it is likely underreported. Esophageal pneumatosis may be idiopathic or secondary to a specific underlying condition. When due to a known cause, introduction of air into the esophageal wall may occur by one or a combination of the following mechanisms: increased intraluminal pressure, mucosal disruption, and dissection of air from a source separate from the esophagus. Processes that increase intraluminal pressure can drive air through small mucosal defects and into the
* Emily R. Neal [email protected] 1
Mount Carmel St. Ann’s Hospital, 500 South Cleveland Avenue, Westerville, OH 43081, USA
2
Radiology Incorporated, 10567 Sawmill Pkwy, Powell, OH 43065, USA
submucosa or deeper muscular layers. Typically this occurs during endoscopy or secondary to gastrointestinal obstruction. Esophageal pneumatosis primarily due to mucosal disruption may be seen with traumatic injuries from esophageal intubation. Infectious, inflammatory, and corrosive esophagitis may also disrupt the mucosa and allow air to enter the esophageal wall. Air entering the mediastinum from the lung, peritoneum, or neck may theoretically course into the esophageal wall through small developmental or acquired defects. Additionally, air from emphysematous gastritis or pneumatosis intestinalis may dissect into an otherwise normal esophagus.
Imaging appearance of esophageal pneumatosis Esophageal intramural air is not readily detected on plain radiographs or fluoroscopic exams, even in retrospect. CT is the most sensitive imaging modality for the detection of air in the esophageal wall. C
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