Spontaneous Intramural Full-Length Dissection of Esophagus Treated with Surgical Intervention: Multidetector CT Diagnosis with Multiplanar Reformations and Virtual Endoscopic Display

Abstract

Intramural esophageal dissection (IED) is an uncommon disorder characterized by separation of the mucosal and submucosal layers of the esophagus. Iatrogenic intervention is the most common cause of IED, but spontaneous dissection is rare. We report an unusually complicated case of spontaneous IED that involved the full-length of the esophagus that necessitated surgical intervention due to infection of the false lumen. In this case, chest computed tomography successfully established the diagnosis and aided in pre-operative evaluation with the use of various image post-processing techniques.

Intramural esophageal dissection after endoscopy: a case report in a hypopharyngeal cancer patient treated with concurrent chemoradiotherapy

“…Intramural esophageal dissection is a relatively rare disorder characterized by a separation of the mucosa and/ or submucosa from deeper muscular layers of the esophagus. [1][2][3] It was first described as "intramural rupture of the esophagus" by Marks and Keet in 1968, and has also been referred to as "esophageal apoplexy" and "submucosal hematoma". [7][8][9] Hanson and co-workers suggested the term of "intramural esophageal dissection" in 1991, because this is an accurate description of the radiologic findings regardless of the pathogenesis.…”

“…Recently, chest CT scan has proven useful for clear identification of the extent of IED and differentiation of IED from acute cardiovascular disease and other esophageal diseases. 1,6) Furthermore, chest CT scan easily detect a small amount of air collection from the esophageal perforation and adjacent mediastinal fat infiltration representing mediastinitis. In this regard, chest CT is superior to fluoroscopic esophagography, and such a one-step procedure would be both convenient and cost-effective for patients.…”

“…In this regard, chest CT is superior to fluoroscopic esophagography, and such a one-step procedure would be both convenient and cost-effective for patients. 1) CT findings of IED have been reported as a mucosal flap with submucosal distribution of gas or contrast material, giving the esophagus the classic double-barreled appearance. 5) In our case, chest CT scans show not only the typical esophageal double lumen but also eccentric esophageal wall thickening and abnormally thin the other side esophageal wall which represent collapsed true lumen and distended false lumen.…”

“…Recently, chest computed tomography (CT) scan has proven useful to assess the full extent of IED, evaluate the presence of esophageal perforation, and differentiate IED from acute cardiovascular disease and other esophageal diseases. 1,6,7) We herein describe a case of IED after endoscopy in a patient with hypopharyngeal cancer treated with concurrent chemoradiotherapy. In this case, chest CT successfully established a diagnosis of IED extending to the gastric wall and a suspicion of microperforation.…”

“…Intramural esophageal dissection (IED) is a rare disorder characterized by a separation of the mucosa and/ or submucosa from deeper muscular layers of the esophagus, with or without perforation. [1][2][3] The causes of IED include mucosal injuries from ingestion of sharp foreign body, abrupt increase in intraesophageal pressure such as forceful vomiting, anticoagulation therapy or inherent coagulopathy, and iatrogenic instrumentation including endoscopy. Among them, iatrogenic instrumentation such as endoscopy is probable the most important risk factor.…”