Epidural abscess resulting from traumatic esophageal rupture secondary to a flexion-extension injury
- 26 Downloads
An epidural abscess developed several weeks after a traumatic esophageal rupture secondary to a reported flexion-extension injury in a restrained back seat passenger in a motor vehicle accident. Chest radiograph and an Indium study suggested the possibility of a posterior mediastinal abscess. Chest computed tomography (CT) also noted epidural abscess and osteomyelitis, which were confirmed by magnetic resonance imaging (MRI). Diagnosis was delayed significantly by underinterpretation of both chest and CT findings. Obvious positive findings (lower lobe infiltrate on chest radiograph and posterior mediastinal abscess on CT) were noted, but more subtle and very important findings of superior mediastinal widening and extra pulmonary gas bubbles on the chest radiograph and extradural disease displacing the spinal cord on CT were not described. We can find no previously reported case of esophageal rupture associated with flexion-extension injury of the neck. It is also extremely rare for esophageal rupture to remain asymptomatic for more than several hours.
Key WordsEpidural abscess Spine Esophagus Trauma Osteomyelitis Whiplash Flexion-extension injury
Unable to display preview. Download preview PDF.
- 1.Wolff AP, Kessler S. Iatrogenic injury to the hypopharynx and cervical esophagus: an Autopsy Study Ann. Otolaryngology 1973;82(6):778–83.Google Scholar
- 2.Michael L, Grillo HC, Malt RA. Operative and non-operative management of esophageal perforation. Ann Surg 1982;32(2):203–10.Google Scholar
- 3.Taveras J, Ferrucci J. Radiology, diagnostic imaging, intervention. Philadelphia: JB Lippincott 1988.Google Scholar
- 4.Berk JE, Bockus MD. Gastroenterology. Vol. 2, 4th Ed. Philadelphia: Saunders, 1985.Google Scholar
- 5.Naumaguchi Y, Rigamonti D, Rothman MI, Sato S, Mihara F, Sadato N. Spinal epidural abscess: evaluation with gadoliniumenhanced MR imaging. Radiographics 1993; May 13(3):545–59.Google Scholar
- 6.Angtuaco EJC, McConnell JR, Chadduck WM, Flanigan S. MR imaging of spinal epidural sepsis. AJNR Am J Neuroradiol 1987;8:879–83.Google Scholar
- 12.Sandhu FS, Dillon WP. Spinal epidural abscess: evaluation with contrast-enhanced MR imaging. AJNR Am J Neuroradiol 1992;12:1087–93.Google Scholar
- 13.Kricun R, Shoemaker EI, Chovanes GI, Stephens HW. Epidural abscess of the cervical spine: MR findings in five cases. AJNR Am J Neuroradiol 1992;158:1145–9.Google Scholar
- 14.Breger RK, Williams AL, Daniels DL, et al. Contrast enhancement in spinal MR imaging. AJNR Am J Neuroradiol 1989;10:633–7.Google Scholar