PMC2816289_01
Preoperative radiography demonstrates a linear band of air (as shown by the arrow) paralleling to the trachea.
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F1
Chest radiograph revealed a small air shadow in the neck (Fig. 1).
Chest CT scan reveals periesophageal fluid collection in the lower esophagus, along with air collection around the esophagus.
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F2
Chest computed tomography showed periesophageal fluid collection in the lower esophagus, more prominent air collection at the left lateral aspect of the lower esophagus, and bilateral minimal pleural effusion (Fig. 2).
Upright view from contrast study shows a 2.5 cm-wide diverticulum and leak on the diverticulum in the left distal esophagus.
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F3
The esophagogram revealed a perforation with a bulge of 2.5 cm in width in the lower thoracic esophagus (Fig. 3).
During the surgery, epiphrenic diverticulum is observed as a mucosal protrusion between the muscular fibers on the left side of the lower thoracic esophagus. The perforation (as shown by the arrow) is revealed in the borderline between mucosal protrusion and muscular fiber.
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F4
At the time of surgery, after esophageal dissection and debridement, a perforated esophageal diverticulum was identified and the perforation was revealed in the borderline between mucosal protrusion and muscular fiber (Fig. 4).
Radiography on the 2nd postoperative day shows the pulmonary edema, cardiomegaly, and widened mediastinum.
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F5
Despite the use of broad spectrum antibiotics postoperatively, the patient's condition deteriorated and follow-up radiography revealed markedly aggravated pulmonary edema, cardiomegaly, and widened mediastinum (Fig. 5) until the 2nd postoperative day.
Contrast study obtained on the 14th postoperative day shows the disappearance of the diverticulum, although the small and confined leak from the esophagus remains.
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F6
A gastrographin swallow study obtained on the 14th postoperative days showed the disappearance of the diverticulum, although there remained small and confined leak from the esophagus (Fig. 6).