Preliminary Diagnosis: Esophageal Rupture
I. What imaging technique is first-line for this diagnosis?
PA and lateral view of the chest and abdomen.
II. Describe the advantages and disadvantages of this technique for diagnosing esophageal rupture.
Advantages
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Relatively inexpensive imaging modality.
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Highly portable imaging modality.
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Exposes patients to negligible radiation.
Disadvantages
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Less sensitive and specific in diagnosing an esophageal perforation compared to a contrast fluoroscopic esophagram or cross sectional imaging.
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Far less adept in detecting the primary location of esophageal rupture and characterizing or detecting any secondary complications.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.
IV. What alternative imaging techniques are available?
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Fluoroscopic guided esophagram.
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CT of the abdomen and pelvis with oral contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing esophageal rupture.
Fluoroscopic guided esophagram
Advantages
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Highly sensitive and specific in detecting the primary pathology.
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Highly adept in characterizing any secondary complications.
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Better detects the site and extent of esophageal rupture than other imaging studies.
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May guide treatment.
Disadvantages
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May expose patients to large amounts of ionizing radiation.
CT of the abdomen and pelvis with oral contrast
Advantages
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Highly sensitive and specific in detecting and characterizing an esophageal perforation and detailing any secondary complications.
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Better guides treatment than plain radiography.
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More sensitive and specific in detecting subtle leaks or fistulas missed by fluoroscopic guided esophagram imaging.
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Offers exquisite detail of the surrounding anatomical structures.
Disadvantages
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Exposes patients to ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
Fluoroscopic guided esophagram
May be contraindicated in pregnant patients.
CT of the abdomen and pelvis with oral contrast
May be contraindicated in pregnant patients.
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