CT DIAGNOSIS OF COMPLETE ESOPHAGEAL RUPTURE IN CHEST TRAUMA

Akhiev M.I.^1,2

 

1 - A.A. Vishnevsky National Medical Research Center for High Medical Technologies – Central Military Clinical Hospital» of the Ministry of Defense of Russia. Krasnogorsk, Russia.

2 - S.M. Kirov Branch of the Military Medical Academy, Ministry of Defense of the Russian Federation. Moscow, Russia.

Purpose. To study the features of visualization and diagnostic significance of signs of complete rupture of the esophagus in primary native CT examination in wounded patients with penetrating wounds of the chest cavity.

Materials and methods. To clarify the CT symptoms of esophageal injuries in the primary CT examination, we performed a retrospective analysis of CT images of patients with penetrating wounds to the chest cavity. Two groups were formed for the analysis - the main and the control. The main group (12 patients) consisted of individuals with complete ruptures of the esophagus, selected from 1040 wounded by an open sample. The control group included 50 patients with penetrating wounds to the chest cavity.

Results. A retrospective analysis of primary CT studies of the chest cavity of 12 cases of complete rupture of the esophagus due to penetrating chest wounds was verified. A set of CT signs characteristic of this injury was identified. A comparison was made with a control group of wounded without esophageal injury. Based on the obtained results, the diagnostic significance and effectiveness of CT were determined.

Discussion. In order to identify signs indicating a possible esophageal rupture and which were clearly evident in the initial CT examination, a retrospective analysis of CT examinations of the chest cavity of the wounded in the main and control groups was performed. In cases of ruptures of the upper third of the esophagus, a large accumulation of air was observed. Comparison of the length and volume of air distribution in the mediastinum in patients of the main and control groups showed a reliable prevalence in the main group. In cases of ruptures of the middle and lower sections of the esophagus, the volume of air was small, it accumulated in isolation in the lower floor of the mediastinum. At the same time, the presence of air in the lower floor of the mediastinum also reliably prevailed in the main group.

Conclusion. CT is an early and effective method for diagnosing esophageal rupture, which is accompanied by air accumulation in the mediastinum, mediastinal expansion, edema of the fatty tissue and local accumulation of fluid/blood in the mediastinum. In case of ruptures at the level of the upper floor of the mediastinum, the saliva symptom has high diagnostic efficiency. In case of ruptures of the middle and lower sections, the volume of air is usually small, its bubbles accumulate in isolation in the lower floor of the mediastinum. Expansion of the mediastinum and compaction of the fatty tissue" display edema. To test the dependence of mediastinal expansion on air accumulation and/or edema of adipose tissue in case of esophageal ruptures, measurements of mediastinal width and densitometric index (DI) of adipose tissue were performed in the main and control groups.

 

Keywords: CT diagnostics of esophageal rupture; gunshot wounds to the chest; pneumomediastinum; esophageal wounds.

 

Corresponding author: Akhiev M.I., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

For citation: Akhiev M.I. CT diagnosis of complete esophageal rupture in chest trauma. REJR 2025; 15(2):73-84. DOI: 10.21569/2222-7415-2025-15-2-73-84.

Received:        29.08.24 Accepted:       03.04.25