PMC9366184_01
The clinical data of the patients. (A) Esophagoscopy showed lesions of the esophageal mucosa (thick arrow). (B) Endoscopic submucosal dissection was performed and part of the muscularis propria was damaged (thick arrow). (C) Microscopic image (hematoxylin-eosin staining; original magnification, x20) of the specimen obtained by endoscopic submucosal dissection showed esophageal low-grade squamous intraepithelial neoplasia. Chest computed tomography 11 days after surgery for the esophageal perforation showed pneumomediastinum (thick arrows) (D) and retropharyngeal emphysema (thick arrow) (E). (F)-(I) Percutaneous ultrasound-guided drainage of the pneumomediastinum through the retropharyngeal space. (F) Ultrasound showed retropharyngeal emphysema posterior to the thyroid (dashed area) and the puncture path (thin arrow) was designed through the space between the thyroid lateral capsule and the carotid artery and internal jugular vein. (G) Ultrasound guidance was used to inject (thin arrow) 10 mL of 1% lidocaine to fill the space (dotted box) between the thyroid lateral capsule and the carotid artery as well as to provide local anesthesia. (H) With use of ultrasound guidance, an 18-gauge needle (thin arrow) was passed in the craniocaudal direction through the skin and sternocleidomastoid muscle, through the liquid barrier between the carotid artery and thyroid, and into the gas cavity. (I) With use of the Seldinger technique, a 12-F pigtail catheter was placed into the emphysema and 10 mL of pus were aspirated. (J)-(L) Chest computed tomography 6 days after ultrasound-guided drainage showed absorption of the pneumomediastinum and retropharyngeal emphysema; (J) sagittal plane; (K) cross section; (L) coronal plane; the arrows indicate the pigtail catheter. A, carotid artery; V, internal jugular vein.
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CT showed absorption of the pneumomediastinum and retropharyngeal emphysema (Figure 1). Chest CT on post-operative Day 30 showed no evidence of residual perforation.