PMC3909853_01
54-year-old man with spontaneous intramural dissection of esophagus.. A. Endoscopy performed at another hospital just prior to admission to our hospital demonstrated laceration (white arrow) in mid-thoracic esophageal mucosa. B, C. Axial (B) and coronal and sagittal images (C) from enhanced CT showed esophageal double lumen, intervening mucosal flap, and absence of mediastinal free air. Air-fluid level and mottled soft tissue densities (white arrowhead) are seen in false lumen (F), consistent with infected fluid and food materials. D. Curved MPR images show two mucosal tears on dissection flap at cervical and mid-thoracic esophagus, and full extent of false lumen in single image plane. Note tears at cervical (open arrowheads) and mid-thoracic (white arrows) esophagus. AA = aortic arch, F = false lumen, T = true lumen. E. Three-dimensional volume rendering images demonstrated mucosal tear (white arrow) in dissection flap between false and true lumens. Note level of tracheal bifurcation (open arrow). Images run from proximal (left, upper) to distal (right, lower) esophagus. F. Virtual CT endoscopic views reconstructed from original CT dataset also depicted endoluminal images of air-distended false lumen, as well as mucosal lacerations on dissection flap (white arrow). False lumen extended from cervical to distal esophagus. Images run from proximal (left, upper) to distal (right, lower) esophagus. F = false lumen, T = true lumen, L = left, R = right, A = anterior, P = posterior. G. Gross surgical specimen of resected esophagus and part of gastric fundus (left end). Resected esophagus was opened longitudinally and stretched. Note thin and whitish esophageal mucosa (white arrows) separated from dark submucosal and muscle layers.
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Endoscopy performed at another hospital just prior to admission revealed a laceration in the thoracic esophageal mucosa (Fig. 1A). C). 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 (Fig. 1D). 3D volume rendering images demonstrated tears on the mucosal flap between the distended false and collapsed true lumen (Fig. 1E). Virtual CT endoscopic (Fig. 1F) 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. Since the clinical and imaging findings supported a diagnosis of a complicated IED with infection, dissected segment was surgically excised (Fig. 1G) and an esophagogastric anastomosis was constructed.