Shimizu Motohiro, Adachi Hiroshi, Sai Kenichi
Department of Intensive Care Medicine, Ryokusen-kai Yonemori Hospital, Kagoshima 890-0062, Japan.
Diagnostics (Basel). 2023 Aug 4;13(15):2600. doi: 10.3390/diagnostics13152600.
Acute phlegmonous esophagitis is a rare life-threatening disease that often requires surgical intervention in case of complications, including esophageal abscess, perforation, or mediastinitis. We present a case of acute phlegmonous esophagitis, in which magnetic resonance imaging (MRI) proved useful in planning the treatment strategy. An 89-year-old woman was admitted to the emergency department with painful swallowing and respiratory distress. She was diagnosed with acute phlegmonous esophagitis and a hypopharyngeal abscess based on computed tomography (CT) findings. However, there was a discrepancy between the clinical course and CT findings. Given the improvement of the patient's condition with conservative treatment with ampicillin/sulbactam, the CT findings suggested an apparent abscess due to increased esophageal wall thickness. However, MR diffusion-weighted images showed a slightly high-intensity signal, suggesting that the enlargement was due to edema rather than an abscess. The patient recovered successfully following conservative treatment. Thus, our findings demonstrate the utility of MRI in the treatment planning of acute phlegmonous esophagitis, especially in cases with unreliable contrast-enhanced CT findings. However, future studies are warranted to explore the utility of MRI in the management of such cases.
急性蜂窝织炎性食管炎是一种罕见的危及生命的疾病，出现包括食管脓肿、穿孔或纵隔炎等并发症时通常需要手术干预。我们报告一例急性蜂窝织炎性食管炎病例，其中磁共振成像（MRI）在制定治疗策略方面被证明是有用的。一名89岁女性因吞咽疼痛和呼吸窘迫入住急诊科。根据计算机断层扫描（CT）结果，她被诊断为急性蜂窝织炎性食管炎和下咽脓肿。然而，临床病程与CT结果之间存在差异。鉴于患者在使用氨苄西林/舒巴坦进行保守治疗后病情有所改善，CT结果显示食管壁增厚导致明显脓肿。然而，磁共振扩散加权图像显示信号略高，提示肿大是由于水肿而非脓肿。患者经保守治疗后成功康复。因此，我们的研究结果证明了MRI在急性蜂窝织炎性食管炎治疗规划中的作用，尤其是在对比增强CT结果不可靠的病例中。然而，有必要进行进一步研究以探索MRI在此类病例管理中的作用。
