Acute Phlegmonous Esophagogastritis Causing Respiratory Distress

Rohit, KO; Baby, Jacob; K, Praveen Valsalan

doi:10.14309/crj.0000000000000042

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…Meanwhile, the low-density area in the right hypopharynx showed no significant change((A): arrow). Acute phlegmonous esophagitis was mainly diagnosed using CT [1][2][3]. However, in our case, even though the diagnosis was established based on CT findings, the contrast-enhanced CT findings were inconsistent with the clinical course of the patient.…”

Section: Figurementioning

confidence: 64%

The Usefulness of Magnetic Resonance Imaging in the Management of Acute Phlegmonous Esophagitis

Shimizu¹,

Adachi²,

Sai³

2023

Diagnostics

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Acute phlegmonous esophagitis is a rare life-threatening disease that often requires surgical intervention in case of complications, including esophageal abscess, perforation, or mediastinitis. We present a case of acute phlegmonous esophagitis, in which magnetic resonance imaging (MRI) proved useful in planning the treatment strategy. An 89-year-old woman was admitted to the emergency department with painful swallowing and respiratory distress. She was diagnosed with acute phlegmonous esophagitis and a hypopharyngeal abscess based on computed tomography (CT) findings. However, there was a discrepancy between the clinical course and CT findings. Given the improvement of the patient’s condition with conservative treatment with ampicillin/sulbactam, the CT findings suggested an apparent abscess due to increased esophageal wall thickness. However, MR diffusion-weighted images showed a slightly high-intensity signal, suggesting that the enlargement was due to edema rather than an abscess. The patient recovered successfully following conservative treatment. Thus, our findings demonstrate the utility of MRI in the treatment planning of acute phlegmonous esophagitis, especially in cases with unreliable contrast-enhanced CT findings. However, future studies are warranted to explore the utility of MRI in the management of such cases.

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Section: Figurementioning

confidence: 64%

The Usefulness of Magnetic Resonance Imaging in the Management of Acute Phlegmonous Esophagitis

Shimizu¹,

Adachi²,

Sai³

2023

Diagnostics

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“…Some patients with APE complain of dyspnea. [ 3 ] A previous study reported that the time from symptom onset to APE treatment ranged from 2 days to 3 weeks, with a median of 5 days. [ 4 ] The patient in this report had a 2-day history of difficulty swallowing and a 1-day history of chest pain; the time to treatment was relatively short in this patient.…”

Section: Discussionmentioning

confidence: 99%

“…APE is diffuse inflammation of the esophagus. [ 3 ] It is associated with a high mortality rate and causes esophageal stenosis or perforation, mediastinitis, and emphysema. [ 2 ] Phlegmonous infections involving the stomach are the most common, while esophageal infections have rarely been reported.…”

Section: Introductionmentioning

confidence: 99%

Acute phlegmonous esophagitis presenting as chest pain: A case report

Chun,

Lee,

Min

et al. 2023

Medicine

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Rationale: Acute phlegmonous esophagitis (APE) is bacterial infection of the submucosal and muscularis layers of the esophagus. APE is a rare but life-threatening disease, and few studies have reported it. Patient concerns: A 63-year-old Korean woman was admitted to the emergency department complaining of chest pain. Contrast-enhanced computed tomography revealed diffuse esophageal wall thickening with low attenuation and paraesophageal fluid collection in the mediastinum. Esophagomyotomy, mediastinal abscess drainage with a right thoracotomy, and left 3-port video-assisted thoracoscopy were performed in the operating room. Diagnoses: Contrast-enhanced computed tomography revealed diffuse esophageal wall thickening with low attenuation and paraesophageal fluid collection in the mediastinum. Interventions: Esophagomyotomy, mediastinal abscess drainage with a right thoracotomy, and left 3-port video-assisted thoracoscopy were performed in the operating room. Outcomes: The patient followed up through an outpatient visit 4 days later discharged. The patient progress was good, and she decided to visit the patient if she had pain afterwards. Lessons: As APE is rare but deadly, strategies to identify APE in patients with chest pain or dysphagia are needed in emergency department.

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“…Patients with phlegmonous esophagitis exhibit a broad spectrum of clinical manifestations that range from fever, sore throat, and chest pain to shock [2][3][4][5][6]. The reported predisposing factors include immunosuppression, alcoholism, uncontrolled diabetes mellitus, old age, malnutrition with low albumin levels, low socioeconomic status, and tumor burden [4].…”

Section: Introductionmentioning

confidence: 99%

Optimal Management of Patients with Phlegmonous Esophagitis: A Systematic Review and Meta-Analysis

Jin,

Woo,

Lee

et al. 2023

JCM

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Goals: To assess the characteristics and prognosis-influencing factors of phlegmonous esophagitis, a rare condition marked by suppurative inflammation of the esophageal submucosa and muscular layers. Background: Effective management strategies for phlegmonous esophagitis are lacking. This study aims to systematically review cases to better understand the disease’s features and prognostic determinants. Method: A systematic search was performed using PubMed/MEDLINE and Google Scholar from inception to 20 April 2023. Phlegmonous esophagitis case reports and studies with patient information were included; clinical manifestations, laboratory results, imaging findings, other diagnostic findings, and outcomes were analyzed. A pooled analysis was performed to investigate mortality-related risk factors. Results: A total of 35 cases of phlegmonous esophagitis were selected from 31 case reports and 2 case series (median age, 57.0 years; male, 54.3%). The patients presented various clinical symptoms, with neck-to-epigastric pain and dysphagia being the most common. Comorbid diabetes mellitus was a major predisposing factor; one-third of the patients had no previous medical history. Computed tomography (CT) and endoscopic examinations were predominantly used for phlegmonous esophagitis diagnosis. Radiological findings showed that the upper and middle esophagus were most frequently involved. Treatments included administration of broad-spectrum antibiotics and drainage via endoscopy or surgery. There were three cases of mortality, and non-survivors tended to have shorter hospital stays, indicating rapid disease progression. In logistic regression, thoracic surgery was a significant mortality-related risk factor (odds ratio, 19.30; 95% confidence interval, 1.33–282.00, p = 0.03). Conclusion: Advancements in CT and endoscopy have led to less-invasive diagnostic and treatment methods for phlegmonous esophagitis. Endoscopic localized abscess treatment is associated with positive outcomes.

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Acute Phlegmonous Esophagogastritis Causing Respiratory Distress

Cited by 4 publications

References 10 publications

The Usefulness of Magnetic Resonance Imaging in the Management of Acute Phlegmonous Esophagitis

The Usefulness of Magnetic Resonance Imaging in the Management of Acute Phlegmonous Esophagitis

Acute phlegmonous esophagitis presenting as chest pain: A case report

Optimal Management of Patients with Phlegmonous Esophagitis: A Systematic Review and Meta-Analysis

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