食管破裂的影像学表现

Imaging presentations of esophageal perforation

目的:探讨食管破裂的影像学表现及不同影像学检查对于临床治疗的意义.方法:搜集2002-06/2008-10我院21例临床诊断食管破裂的临床及影像学资料.其中胸部X线检查10例,颈椎X线检查2例,食道造影检查11例(其中碘水造影7例,钡剂造影4例),9例患者接受螺旋CT扫描(其中2例增强扫描).分析患者的综合影像学表现.结果:10例胸片,发现液气胸4例,胸腔积液4例,3例合并肺部感染;7例出现纵隔改变,其中纵隔气肿3例,纵隔增宽3例,纵隔内气液平面1例;4例出现颈、胸壁皮下气肿.2例颈椎侧位片中,1例提示颈前区软组织增厚,另1例发现颈部含液气平面囊腔.11例食管造影检查中,除2例碘剂造影阴性外,9例均表现造影剂溢出食管外;4例显示黏膜下造影剂积聚.9例CT检查,5例显示破裂区食管周围可见不规则软组织影,内呈气体或液体混杂密度,4例显示食管壁局限不规则增厚,4例显示纵隔或膈下脓肿形成;2例增强CT提示脓肿形成,脓肿壁环行强化.结论:食管造影检查及CT检查是诊断食管破裂的主要影像学手段,而通过CT观察组织炎性改变对于外科治疗方式的选择尤为重要.

AIM： To illustrate imaging presentations related to esophageal perforation and their significance for therapeutic decisions. METHODS： We studied 21 patients with suspected esophageal injury from June 2002 to October 2008 at our hospital. Ten patients underwent standard chest radiography and 2 patients were submitted to cervical plain film, while 11 patients with suspected esophageal perforation were submitted to gastrografin swallow study （7 with iodine and 4 with barium）. Nine patients underwent row spiral CT examination （2 with enhancement）. Imaging presentations were compared and analyzed. RESULTS： Chest radiography （n = 10） revealed hydropneumothorax in 4/10 and pleural effusions in 4/10, and pulmonary infection were observed in 3/10; Changes of mediastinum were seen in 7/10 patients, pneumomediastinum in 3 cases, mediastinum widen in 3 cases, and airfluid level in 1 case. Subcutaneous emphysema in the neck, chest was noted in 4/10. Esophagography （n = 11） demonstrated contrast medium extravasation in 9/11, indicating a submucosal contrast medium collection in 4/11, except for 2 cases with negative finding. Enhanced CT scans （n = 9） revealed periesophageal air and fluid collections with irregular soft tissue masses in 5/11 patients, thicken wall with typical localization in 4/11, abscess formation in mediastinum or under diaphragm in 4/11. Contrast-enhanced CT （n = 2） demonstrated abscess formation with contrast enhancement of the margins. CONCLUSION： Esophagography and CT examination are the main diagnosis methods for suspected esophageal perforation. CT findings of inflammatory reaction for esophageal perforation are especially important for surgical treatment.