Imaging in the Evaluation of Esophageal Trauma Including Surgery

Esophageal perforation and anastomotic leak of the postsurgical esophagus place patients at significant risk for morbidity and mortality, requiring prompt and accurate diagnosis through imaging. Plain radiographs may be obtained during the initial evaluation of symptoms but have low sensitivity and specificity for esophageal perforation. With clinical suspicion for perforation, CT with oral contrast should be obtained initially due to its high sensitivity, utility in surgical planning, and usefulness in evaluating underlying causes or other etiologies for symptoms. With a negative CT, perforation is ruled out and subsequent fluoroscopic esophagography is unnecessary. In patients with postsurgical anatomy such as esophagectomy, diagnosis is difficult and concurrent review of CT and fluoroscopy is more sensitive than either modality alone.