PMC3959943_01
PMC3959943_02
Patient 2: (A) CT scan. Mediastinal air and extravasated contrast are present below the level of the carina compatible with rupture of the distal esophagus. Air extends into the gastrohepatic space. (B) Water-soluble contrast esophagram. Contrast leaks behind the stomach as well and from the right aspect of the esophagus consistent with perforation. Patient 3: (C) CT scan. Pneumomediastinum is present as well as air dissecting into the pericardium, but no frank defect is visualized in the trachea or esophagus. (D) Barium esophagram following initial evaluation with water-soluble contrast esophagram. There is no evidence of esophageal leak and no contrast extravasation
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F1
CT scan (Fig. 1C). Contrast swallow revealed no evidence of contrast extravasation (Fig. 1D).
(A) Transmural esophageal biopsy at time of presentation of Patient 2 demonstrating eosinophilic infiltration into the muscularis propria. Approximately 40 eosinophils per high power field (EOS/ HPF). (H&E stain, 10x magnification). Insert. Evidence of eosinophils infiltrating the muscularis propria of the esophagus. (H&E stain, 40x magnification). (B) Esophageal mucosa after treating Patient 2 with steroids showing no evidence of eosinophils. (H&E stain, 40x magnification)
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F2
Full thickness resection specimen revealed increased transmural eosinophilia with multiple fields demonstrating >25 eosinophils/hpf and up to 55 eosinophils/hpf, consistent with EoE (Fig. 2A and insert). Surgical specimen at that time showed no evidence of eosinophilia (Fig. 2B), suggesting improvement following systemic corticosteroid therapy.
PMC3959943_03
Patient 2: (A) CT scan. Mediastinal air and extravasated contrast are present below the level of the carina compatible with rupture of the distal esophagus. Air extends into the gastrohepatic space. (B) Water-soluble contrast esophagram. Contrast leaks behind the stomach as well and from the right aspect of the esophagus consistent with perforation. Patient 3: (C) CT scan. Pneumomediastinum is present as well as air dissecting into the pericardium, but no frank defect is visualized in the trachea or esophagus. (D) Barium esophagram following initial evaluation with water-soluble contrast esophagram. There is no evidence of esophageal leak and no contrast extravasation
AnnGastroenterol-26-166-g002.jpg
PMC3959943_03_AnnGastroenterol-26-166-g002.jpg
F1
CT scan (Fig. 1C). Contrast swallow revealed no evidence of contrast extravasation (Fig. 1D).
PMC3959943_04