Medicine of the Future in America

Category Archives: Direct aortic injury

Esophageal foreign body causing direct aortic injury: DISCUSSION (Part 3)

The role of CT in foreign body esophageal perforation has been documented. A retrospective study of the CT scans of 12 patients with esophageal perforation revealed that extraluminal air was the most useful finding. The evaluated features, however, are not pathognomonic for esophageal perforation. The role of CT is not to confirm a highly suspicious case of esophageal perforation due to a foreign body but to provide further evidence in atypical cases. In the case presented, the fish bone was easily seen and the surrounding hematoma confirmed the observation that vascular injury was likely. Continue reading

Esophageal foreign body causing direct aortic injury: DISCUSSION (Part 2)

Although the bleeding seen on gastroscopy could have been a result of esophageal venous plexus injury, it is more likely that aortic injury had occurred. Bleeding from esophageal perforation most commonly results in intramural hematomas, but focal thickening of the esophageal wall was not seen. There are no case reports of intramural esophageal bleeding resulting in mediastinal hematomas as was seen in this case. Continue reading

Esophageal foreign body causing direct aortic injury: DISCUSSION (Part 1)

foreign body ingestionEsophageal perforation occurs in 1% to 4% of instances of foreign body ingestion. These complications carry a considerable morbidity from mediastinitis, paraesophageal abscess, pericarditis, pneumothorax, pyopneumothorax and pneumomediastinum. In a series of 511 cases of esophageal perforation, there is a reported mortality of 22%. Foreign body perforation was the etiology of 7% in that series. This condition, although uncommon, must be recognized in the appropriate clinical context. Continue reading

Esophageal foreign body causing direct aortic injury (Part 3)

Increased attenuation in the mediastinal fat surrounding the thoracic esophagus was present, as were small locules of extraluminal air compatible with perforation (Figure 3). Small bilateral pleural effusions with accompanying bibasilar atelectasis were also noted. An aortogram was also performed, which did not show an aortic leak. The patient was resuscitated with three units of packed red blood cells and underwent a right hemithoracotomy the following day. Continue reading

Esophageal foreign body causing direct aortic injury (Part 2)

The patient was seen by the cardiovascular surgery service during which she had two episodes of fresh hematemesis. Her hemoglobin was 118 g/L at the peripheral hospital and dropped to 100 g/L after the hematemesis. There was no antecedent history of melena or gastrointestinal bleeding in the past. She was a lifelong nonsmoker, did not use alcohol and there was no history of acetylsalicylic acid or nonsteroidal anti-inflammatory drug use. Her hepatitis B and C status was unknown. There was no history of peptic ulcer disease. Continue reading

Esophageal foreign body causing direct aortic injury (Part 1)

direct aortic injuryEsophageal perforation and its complications have been well documented in the literature. Documented etiologies include tumours, iatrogenic causes, trauma and foreign body ingestion. Foreign body ingestion is an uncommon cause of esophageal perforation but the complications associated with a prolonged impaction can result in considerable morbidity and mortality. Although there have been many cases reported of aortoesophageal fistulae following foreign body ingestion, little has been published about direct aortic injury from a foreign body. Because esophageal perforation and vascular injury usually present as hematemesis or melena, gastroenterologists should be aware of this diagnostic possibility. We present a case of esophageal perforation associated with direct vascular injury related to an aortic puncture caused by a fish bone. Looking for a great online pharmacy you could trust and where you could find cephalexin antibiotic at best prices? You have one pharmacy like that already and can finally enjoy the best quality of service ever experienced.

CASE PRESENTATION

A previously healthy 59-year-old woman presented to a local infirmary with a 3 h history of retrosternal chest pain. The pain began immediately after eating a meal of fish. The restrosternal chest pain was pleuritic in nature. The patient had odynophagia. She was treated conservatively with antacids and discharged home. She returned two days later because the pain persisted and began to radiate to the intrascapular region. She became diaphoretic and pale. There were no complaints of nausea or vomiting. The patient was then seen at a peripheral hospital where the possibility of aortic dissection was considered. She was transferred to this hospital for further investigation.

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