PMC10070333_01
Cervical spine magnetic resonance imaging (MRI), sagittal sequences, contrast-enhanced T1-weighted (a), and T2-weighted (b) marked abnormality of the C4-C5-C6 vertebral bodies, with fragmentation and destruction of the endplates resulting in focal kyphosis. Dense material on the epidural space, mainly on the ventral side, suggestive of epidural abscess causing mass effect on the pharyngoesophageal tract posterior wall was detected. The infection also involved the surrounding soft paravertebral tissues. Severe mass effect on the spinal cord, which appears markedly compress and posteriorly displaced, was also evident. Postcontrast cervical spine MRI, T1-weighted sequence (c) 8 months after discharge and after prolonged antibiotic therapy. The inflammatory process was resolved resulting in multilevel degenerative changes. Severe myelopathy signal spanning from C3 to C6 level persisted. Cervical radiogram, sagittal projection (d). The correct position of the stabilization system composed by a titanium plate and six screws was evident.
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F1
Intense and diffuse contrast enhancement of the paravertebral soft tissues from C2 to T1 was also found [Figures 1a and b]. In the following months, the neurological conditions moderately improved, laboratories and neuroradiological examinations showed the progressive resolution of the infectious disease but resulting in multilevel degenerative changes with severe myelopathy [Figure 1c]. A postoperative radiogram confirmed the correct position of the implant [Figure 1d].
Barium-swallow study. (a) It was possible to appreciate the pharyngoesophageal perforation through a contrast medium leakage at the pharyngoesophageal junction. Magnetic resonance of the cervical spine, T2-weighted sequence. (b) It is possible to appreciate the persistence of the myelopathy signal and the pharyngoesophageal-cutaneous fistula (white arrow).
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F2
A barium-swallow study was able to detect PEP, lesser than 1 cm on maximum diameter, through a contrast medium leakage at the pharyngoesophageal junction, close to the cervical plate [Figure 2a]. A MRI of the cervical spine confirmed the presence of the pharyngoesophageal-cutaneous fistula [Figure 2b].
Barium-swallow study. The resolution of the pharyngoesophageal fistula was detected with the absence of contrast diffusion out of the lumen.
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F3
Serial barium-swallow studies documented a progressive improvement until the resolution of the fistula [Figure 3]; thus, parenteral nutrition was suspended, and the nasogastric tube was positioned.