Retrospective study of detecting oesophageal injuries post neck trauma: CTA versus fluoroscopy.

Background: Timely detection of oesophageal injuries post-penetrating neck trauma is imperative because of the associated high morbidity and mortality. Patients commonly undergo both CT angiography (CTA) and contrast swallow studies (fluoroscopic oesophagography) when oesophageal injury is suspected.

Objectives: To determine the radiological findings of oesophageal injury after penetrating neck trauma comparing CTA and fluoroscopic oesophagography at a single tertiary centre.

Method: The study retrospectively reviewed the data from CTA and fluoroscopic oesophagography reports of patients suspected of oesophageal injuries secondary to penetrating neck trauma at a tertiary hospital in South Africa from January 2018 to December 2022.

Results: A total of 76 records were reviewed. The mean age for the participants was 31.5 years, ranging from 0.75-66 years. In this study 6/76 (8%) patients had confirmed oesophageal injury on fluoroscopy, which is considered the gold standard. The majority of penetrating neck injuries were in the 20-29 year age group, with 33/76 (43%) injuries. Stab wounds as the mechanism of injury accounted for 57/76 (75%). Dysphagia was experienced by 10/76 (13%) of those who had injuries. Zone I injuries accounted for 33/76 (43%) of the injuries.

Conclusion: The incidence of oesophageal injuries secondary to penetrating neck injuries is comparable to previous studies. This study determined that CTA has a high sensitivity but low specificity.

Contribution: Fluoroscopic oesophagography should, therefore, be performed in patients who have an abnormal CTA coupled with clinical signs and symptoms of oesophageal injury.