Spontaneous Intramural Full-Length Dissection of Esophagus Treated with Surgical Intervention: Multidetector CT Diagnosis with Multiplanar Reformations and Virtual Endoscopic Display
A 54-year-old man was admitted to our hospital with a several-day history of chest pain and swallowing difficulty. The chest pain had commenced after he drank alcohol. Endoscopy performed at another hospital just prior to admission revealed a laceration in the thoracic esophageal mucosa (). The patient had been diagnosed with diabetes mellitus 10 years previously.\nUpon admission, chest CT was performed under the impression of esophageal perforation to assess the underlying esophageal causes and mediastinal complications. Axial, coronal, and sagittal images revealed the esophageal double lumen and the absence of free air in the mediastinum (). Curved multiplanar reconstruction images showed the full extent of false lumen with two tears on mucosal flap at cervical and mid-thoracic esophagus in a single image plane (). 3D volume rendering images demonstrated tears on the mucosal flap between the distended false and collapsed true lumen (). Virtual CT endoscopic () views from the same CT dataset also depicted an elliptically shaped laceration on the dissection flap and an air-distended false lumen extending from the cervical to the distal esophagus, comparable to what was seen on the fiberoptic endoscopic view.\nEven though he experienced dysphagia and chest pain, the patient had not ceased to eat and drink prior to admission, and consequently developed signs of infection (high fever and an elevated blood white blood cell count) that were apparent on admission. Since the clinical and imaging findings supported a diagnosis of a complicated IED with infection, dissected segment was surgically excised () and an esophagogastric anastomosis was constructed. Abundant pus and food material were found in the distal blind end of the false lumen of the surgical specimen. The presence of cervical and mid-thoracic mucosal tears was also confirmed upon specimen examination.