Overcast WB, Taylor C, Capps AE, Steenburg SD. Utility of fluoroscopic oesophagography in the setting of spontaneous and blunt traumatic pneumomediastinum.
Clin Radiol 2023;
78:e214-e220. [PMID:
36572600 DOI:
10.1016/j.crad.2022.11.003]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 12/26/2022]
Abstract
AIM
To determine the incidence of positive fluoroscopic oesophagography in patients presenting with spontaneous or blunt traumatic pneumomediastinum.
MATERIALS AND METHODS
Retrospective chart review was performed on patients who underwent fluoroscopic oesophagography for spontaneous or blunt traumatic pneumomediastinum between 2001-2019. Patients were excluded for history of oesophageal surgery, penetrating trauma, oesophageal cancer, or tracheal/oesophageal instrumentation.
RESULTS
Two hundred and fifty-two patients met the inclusion criteria; 170 presented with spontaneous pneumomediastinum and 82 presented with blunt traumatic pneumomediastinum. Fluoroscopic oesophagography was positive in eight patients with spontaneous pneumomediastinum, for a positivity rate of 4.7% (8/170). There was one false-negative case in a patient who presented with spontaneous pneumomediastinum and was found to have a non-full-thickness oesophageal injury on endoscopy. Fluoroscopic oesophagography was negative in all patients with blunt traumatic pneumomediastinum (0/82). The sensitivity and specificity of fluoroscopic oesophagography were 88.9% (8/9) and 100% (243/243), respectively. Oesophageal injury was more common in patients with spontaneous pneumomediastinum and a pleural effusion (5/11, 45.4%) than in patients with spontaneous pneumomediastinum and no pleural effusion (4/159, 2.5%, p<0.001).
CONCLUSION
The present findings do not support routine oesophagography in patients with blunt traumatic pneumomediastinum. Conversely, a positivity rate of 4.7% in patients with spontaneous pneumomediastinum suggests oesophagography may be warranted in this population, particularly if an associated pleural effusion is present.
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