Salehpoor Ali, Thompson William
Department of Radiology, University of New Mexico School of Medicine, Albuquerque, USA.
Abdom Radiol (NY). 2025 Jul 28. doi: 10.1007/s00261-025-05142-0.
Esophageal perforation is a rare but life-threatening condition with a variety of causes, including iatrogenic injury, spontaneous rupture, and trauma. Early and accurate diagnosis is critical due to the condition's high morbidity and mortality. The evaluation of esophageal trauma relies heavily on imaging, where CT with oral contrast and fluoroscopy are the primary tools for diagnosis and management. The high sensitivity of CT allows radiologists to exclude esophageal perforation when negative and eliminates the need for subsequent and more time and resource intensive fluoroscopic evaluation. Diagnostic challenges increase in the postoperative patient, requiring multimodality imaging evaluation. CT is the preferred initial modality due to its superior sensitivity for detecting extraluminal air, fluid collections, and oral contrast extravasation. Fluoroscopic esophagography is complementary to CT in postoperative cases, as the dynamic nature of fluoroscopy allows differentiation of apparent extraluminal contrast seen on CT depending on whether it stays fixed in location or is freely communicating.
食管穿孔是一种罕见但危及生命的疾病，病因多样，包括医源性损伤、自发性破裂和外伤。由于该病的高发病率和死亡率，早期准确诊断至关重要。食管创伤的评估严重依赖影像学检查，口服对比剂的CT和荧光透视是诊断和管理的主要工具。CT的高灵敏度使放射科医生在结果为阴性时能够排除食管穿孔，从而无需进行后续更耗时且资源密集的荧光透视评估。术后患者的诊断挑战增加，需要多模态影像学评估。CT因其在检测腔外气体、液体积聚和口服对比剂外渗方面具有更高的灵敏度，是首选的初始检查方式。在术后病例中，荧光透视食管造影是CT的补充检查，因为荧光透视的动态特性能够根据CT上显示的腔外对比剂是固定在某个位置还是自由流通来进行鉴别。
