Merav Galper BA, MD, Presenter: Nothing to Disclose

Christopher D'Arcy Scheirey MD, Abstract Co-Author: Nothing to Disclose

Francis Joseph Scholz MD, Abstract Co-Author: Owner, FSpoon Company

1) Prompt recognition of esophageal injury is critical for clinical management 2) Suspected esophageal trauma producing dysphagia warrants urgent fluoroscopic examination 3) Special techniques must be employed for optimal visualization of injuries 4) Fluoroscopic staging of esophageal trauma differs from the AAST and other esophageal injury scales and is based on degree of mural damage  

1) Background of esophageal trauma 2) Perforation etiologies a. Instrumentation b. Ingestion/vomiting c. Fragile mucosa (e.g. bullous dermatoses, eosinophilic esophagitis) d. Radiation stricture e. Caustic agents 3) When/Why fluoroscopy? a. Signs and symptoms: odynophagia, neck crepitus, abnormal breath sounds b. Symptomatic: fluoroscopy is best first test for subtle injuries and staging c. Critically ill: CT and/or surgery d. Pneumomediastinum without odynophagia: no benefit from esophagography; Macklin effect is discussed 4) Technique a. Water-soluble, 90 cc, 4/s AP pharynx; 1/s AP esophagus b. If negative: barium Pharynx: 4/s AP, Lateral Esophagus: 1/s, upright AP, LAO and prone LPO 5) Esophageal Trauma Staging a. Mucosal – “Taco Tear,” Mallory-Weiss Syndrome b. Intramural – “Esophageal tear drop” sign c. Transmural – Boerhaave Syndrome d. Intramural Hematoma – “Ribbon” sign  

http://abstract.rsna.org/uploads/2014/14007100/14007100_twqj.pdf

Galper, M, Scheirey, C, Scholz, F, Fluoroscoping Esophageal Trauma.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007100.html