Neglected esophageal perforation after upper thoracic vertebral fracture.
BACKGROUND
Esophageal perforation associated with thoracic fracture is extremely rare. If not diagnosed at an early stage, it can lead to life-threatening complications, such as mediastinitis and sepsis.


OBJECTIVE
To report a case of esophageal perforation after T2 compression fracture that was initially missed and subsequently developed into osteomyelitis involving adjacent vertebrae.


METHODS
A case report and review of the literature.


METHODS
A 49-year-old man with severe upper thoracic back pain and intermittent fever was referred to our hospital. Five months before presentation, the patient was diagnosed with compression fracture of T2 vertebra with a teardrop fragment. On initial computed tomography (CT) and magnetic resonance imaging (MRI), there was no appreciable periesophageal-free gas. However, the posterior wall of the esophagus was compressed by a beak-like fracture fragment. Magnetic resonance imaging showed an infectious spondylitis of T1-T2, which mimicked esophageal cancer with local tumor infiltration. No dye leakage from the esophagus was found on contrast esophagography.


RESULTS
After empiric antibiotic therapy for 4 months, subsequent radiographs of the spine did not reveal any further collapse or destruction of the vertebral bodies, and inflammatory markers returned to normal limits. There was no recurrence of symptoms at the 2-year follow-up.


CONCLUSIONS
Esophageal perforation after upper thoracic vertebral fracture can develop when the fracture fragment pierces the posterior wall of the esophagus. In addition to periesophageal-free air, crushing, distortion, or marked displacement of the esophagus at the cervicothoracic junction on CT or MRI is a clue to potential esophageal injury. If not identified early, patients may present with chronic osteomyelitis extending to adjacent vertebrae.
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong, Songpa-gu, Seoul, Korea.
Dong-Ho
DH
Lee
Nam Heun
NH
Kim
Chang Ju
CJ
Hwang
Choon Sung
CS
Lee
Yung-Tae
YT
Kim
Myung Jin
MJ
Shin
Samuel K
SK
Cho
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003951:Diagnostic Errors; D004939:Esophageal Perforation / Q000150:complications / Q000175:diagnosis*; D050815:Fractures, Compression / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases; D010019:Osteomyelitis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis*; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents