Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study

Abstract

Purpose

Esophageal perforation has a high mortality rate. Fluoroscopic esophagography (FE) is the procedure of choice for diagnosing esophageal perforation. However, FE can be difficult to perform in seriously ill patients.

Methods

We retrospectively reviewed charts and scans of all patients who had undergone thoracic CT (TCT) without oral contrast and FE for suspicion of esophageal perforation at our hospital between October, 2010 and December, 2015. Scans were interpreted by a single consultant radiologist having > 5 years of relevant experience. Statistical analysis was performed using SPSS version 20. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TCT were computed using FE as reference standard.

Results

Of 122 subjects, 106 (83%) were male and their median age was 42 [inter-quartile range (IQR) 29–53] years. Esophageal perforation was evident on FE in 15 (8%) cases. Sensitivity, specificity, PPV and NPV of TCT for detecting esophageal perforation were 100, 54.6, 23.4 and 100%, respectively. When TCT was negative (n = 107), an alternative diagnosis was evident in 65 cases.

Conclusion

Thoracic computed tomography (TCT) had 100% sensitivity and negative predictive value for excluding esophageal perforation. FE may be omitted in patients who have no evidence of mediastinal collection, pneumomediastinum or esophageal wall defect on TCT. However, in the presence of any of these features, FE is still necessary to confirm or exclude the presence of an esophageal perforation.

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Corresponding author

Correspondence to Muhammad Awais.

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Conflict of interest

Muhammad Awais, Saqib Qamar, Abdul Rehman, Noor Ul-Ain Baloch and Gulnaz Shafqat have no conflict of interests to disclose.

Ethical standards

All procedures related to this study were performed in accordance with ethical standards of the institutional ethics review committee and with the most recent version of the Declaration of Helsinki (1964).

Informed consent

As this was a retrospective study, formal consent was not required and requirement of informed consent was waived.

Additional information

This study was presented as a Scientific Exhibit at the European Congress of Radiology (ECR) 2016 held at Vienna, Austria.

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Awais, M., Qamar, S., Rehman, A. et al. Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study. Eur J Trauma Emerg Surg 45, 517–525 (2019). https://doi.org/10.1007/s00068-018-0929-4

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Keywords

  • Esophageal perforation
  • Computed tomography
  • Contrast swallow
  • Fluoroscopy
  • Esophagography