CT oral contrast and contemporary imaging pathways for suspected oesophageal perforation in the emergency department: a retrospective observational study.

IF 1.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Emergency Radiology Pub Date : 2026-10-01 Epub Date: 2026-08-14 DOI:10.1007/s10140-026-02532-9

Samyak Shah, Adil Zia, Bruno Di Muzio

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引用次数: 0

Abstract

Purpose: To evaluate contemporary computed tomography (CT) imaging pathways for Emergency Department (ED) patients with suspected oesophageal perforation or leak, with a particular focus on oral contrast utilisation, radiologic findings and downstream investigations following the index CT examination.

Methods: We performed a single-centre retrospective observational study of all adult ED patients who underwent CT imaging including the chest for suspected oesophageal perforation or leak between January 2015 and March 2026. Patients were identified through radiology database search. Demographics, clinical indications, oral contrast use, radiologic findings and investigations performed within five days of the index CT were recorded.

Results: A total of 107 patients were included, with six (5.6%) confirmed oesophageal perforations. Oral contrast was administered in 62 (57.9%) CT examinations. Overall, 45 patients (42.1%) underwent downstream investigations, with similar rates regardless of oral contrast administration (43.5% vs. 40.0%). However, repeat CT was less frequent following oral contrast-enhanced CT (3.2% vs. 17.8%). Among patients with confirmed perforation, direct signs including oesophageal wall defect and extraluminal contrast leak were common (66.7% each), whilst indirect signs were also frequent present, including pneumomediastinum and pleural effusion (83.3% each). Pneumomediastinum was also frequently observed in patients without perforation.

Conclusion: Rates of downstream investigation were similar regardless of oral contrast administration, however, repeat CT was less frequently performed following oral contrast-enhanced examinations. These findings suggest that oral contrast may influence subsequent imaging pathways. Prospective studies are warranted to determine whether selective oral contrast administration can improve diagnostic confidence while reducing unnecessary CT examinations.

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急诊疑似食道穿孔的CT口腔造影和当代影像学检查：回顾性观察研究。

目的：评估急诊部（ED）疑似食管穿孔或渗漏患者的当代计算机断层扫描（CT）成像途径，特别关注口服造影剂的应用、放射学表现和指数CT检查后的下游调查。方法：我们对2015年1月至2026年3月期间因疑似食管穿孔或渗漏而接受CT成像（包括胸部）的所有成年ED患者进行了一项单中心回顾性观察研究。通过放射学数据库检索确定患者。记录人口统计学、临床适应症、口服造影剂使用、放射学表现和指数CT后5天内进行的调查。结果：共纳入107例患者，其中确诊食管穿孔6例（5.6%）。在62例（57.9%）CT检查中给予口服造影剂。总体而言，45名患者（42.1%）接受了下游调查，无论口服造影剂给药与否，其比例相似（43.5%对40.0%）。然而，口服增强CT后重复CT的频率较低（3.2%对17.8%）。在确诊穿孔的患者中，直接征象包括食管壁缺损和腔外造影剂泄漏较为常见（各占66.7%），间接征象也较为常见，包括纵隔气肿和胸腔积液（各占83.3%）。纵隔气肿也常见于无穿孔的患者。结论：无论口服对比剂使用与否，下游调查率相似，然而，口服对比剂增强检查后重复CT检查的频率较低。这些发现表明，口腔造影剂可能影响随后的成像途径。有必要进行前瞻性研究，以确定选择性口服造影剂是否可以提高诊断信心，同时减少不必要的CT检查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Emergency Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

4.60

自引率

4.50%

发文量

期刊介绍： To advance and improve the radiologic aspects of emergency careTo establish Emergency Radiology as an area of special interest in the field of diagnostic imagingTo improve methods of education in Emergency RadiologyTo provide, through formal meetings, a mechanism for presentation of scientific papers on various aspects of Emergency Radiology and continuing educationTo promote research in Emergency Radiology by clinical and basic science investigators, including residents and other traineesTo act as the resource body on Emergency Radiology for those interested in emergency patient care Members of the American Society of Emergency Radiology (ASER) receive the Emergency Radiology journal as a benefit of membership!