All that hurts in chest is not love; An insight to non-traumatic, non-vascular mediastinal emergencies in adults

Congress:

ECR 2020

Poster Number:

C-08284

Type:

Educational Exhibit

Keywords:

Performed at one institution, Cross-sectional study, Retrospective, Acute, Dynamic swallowing studies, Diagnostic procedure, Abscess delineation, MR, CT, Conventional radiography, Mediastinum, Interventional non-vascular, Emergency, Emergency Imaging

Authors:

M. D. Sarfraz, M. Rauf, B. Y. Faiz, S. Gul; Islamabad/PK

DOI:

10.26044/ecr2020/C-08284

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-08284

Fig. 1: Classification of Non-traumatic, Non-vascular mediastinal emergencies in adults.

Fig. 2: Boerhaave Syndrome; A 27 year old male presented with chest pain and repetitive...

Fig. 17: Tension pneumomediastinum; A 22 year old male with esophageal perforation. A:...

Fig. 18: Tension pneumopericardium,a 32 year old male with fistulous communication...

Fig. 13: Mediastinitis secondary to post-surgical wound dehiscence; A 57 years old male...

Fig. 15: Mediastinitis secondary to adjacent osteomyelitis; A 66 years old male...

Fig. 5: Non-malignant esophageal fistula; An 18 year old female, known case of Potts...

Fig. 10: Descending necrotizing mediastinitis; A 67 years old diabetic patient presented...

Learning objectives

Classifying non-traumatic, non-vascular mediastinal emergencies in adults. Describing important imaging findings and clues, helping in diagnosis of non-traumatic, non-vascular mediastinal emergencies.

Background

Commonest causes of chest pain are cardiovascular accident, trauma and love. Among adults with acute chest pain who visit emergency departments,as many as 30% receive a diagnosis of acute myocardial infarction or unstable angina1. Other mediastinal causes of acute chest pain include blunt or penetrating trauma and vessel-related conditions such as pulmonary thromboembolism and acute aortic syndromes2. A small unique group of mediastinal emergencies which are neither trauma-related nor vascular are easily missed, leading to increase in morbidity and mortality of patients. Our study classifies...

Findings and procedure details

ESOPHAGEAL EMERGENCIES: CASE 1: BOERHAAVE SYNDROME It is described ascomplete transmural laceration of the esophagus that results from violent straining or vomiting. CASE 2: IATROGENIC ESOPHAGEAL PERFORATION It usually occurs post-endoscopy resulting in inflammation of mediastinal structures due to leakage of fluid and food material. CASE 3: MALIGNANT ESOPHAGEAL PERFORATION With increase in size of esophageal tumor, it may rupture leading to mediastinal inflammation. CASE 4: NON-MALIGNANT ESOPHAGEAL FISTULA Acquired esophageal fistula in adults is a rare but serious condition. CASE 5: MALIGNANT ESOPHAGEAL FISTULA...

Conclusion

Although clinical findings of non-vascular, non-traumatic mediastinal emergencies may be nonspecific, imaging findings are often definitive. Awareness of various non-vascular, non-traumatic mediastinal emergencies and recognizing their specific imaging findings is crucial for making an accurate and timely diagnosis to facilitate appropriate patient management.

Personal information and conflict of interest

M. D. Sarfraz; Islamabad/PK - nothing to disclose S. Gul; Islamabad/PK - nothing to disclose B. Y. Faiz; Islamabad/PK - nothing to disclose D. M. Rauf; Islamabad/PK - nothing to disclose

References

Bonomo L, Di Fabio F, Rita Larici A, Merlino B,Luigia Storto M. Non-traumatic thoracic emergencies: acute chest pain—diagnostic strategies. Eur Radiol 2002;12(8):1872–1885. Venkata S. Katabathina, Carlos S. Restrepo, Santiago Martinez-Jimenez, Roy F. Riascos(2011). Nonvascular, Nontraumatic Mediastinal Emergencies in Adults: A Comprehensive Review of Imaging Findings.RadioGraphics, 31(4), pp.1141-1160. Jeudy J, Waite S, White CS. Nontraumatic thoracic emergencies. Radiol Clin North Am 2006;44(2): 273–293, ix. Sinha R. Naclerio’s V sign. Radiology 2007;245(1):296–297. Cherveniakov A, Tzekov C, Grigorov GE, Cherveniakov P. Acquired benign esophago-airway fistulas. Eur J Cardiothorac...