title: Esophagography after pneumomediastinum without CT findings of esophageal perforation: is it necessary?
abstract: OBJECTIVE
  The purpose of our study was to determine the necessity of fluoroscopic esophagography in patients with pneumomediastinum on CT but without CT findings of esophageal perforation.
  
  
  METHODS
  From January 1, 2006, through December 31, 2010, there were 4305 fluoroscopic esophagography examinations including 533 with CT identified from a search of our PACS. Patients with pneumomediastinum on CT who were subsequently referred for emergent fluoroscopic esophagography to exclude esophageal perforation were enrolled. Fluoroscopic esophagography examinations performed within 3 days of CT were included. Patients with a history of esophageal disease were excluded. As a result, 103 patients were enrolled in the study; patients were divided into groups on the basis of whether there was additional clinical history of esophageal damage (trauma group) or not (nontrauma group). Images were reviewed by two board-certified radiologists blinded to the clinical data and radiologic reports for the presence or absence of esophageal perforation. A positive result on CT was defined as esophageal injury or periesophageal infiltration that coexisted with periesophageal air. A positive fluoroscopic esophagography result was defined as oral contrast medium leakage from the esophagus.
  
  
  RESULTS
  Esophageal perforation was diagnosed in 15 of the 103 patients. The CT findings were significantly correlated with esophageal perforation (p < 0.001 in the trauma group, and p = 0.001 in the nontrauma group). The respective sensitivity and negative predictive value (NPV) of CT versus fluoroscopic esophagography in the trauma group were 100% versus 66.7% and 100% versus 87.9%; in the nontrauma group, the sensitivity and NPV were 100% for CT and fluoroscopic esophagography. Thus, the sensitivity and NPV of CT were either superior or equal to those of fluoroscopic esophagography.
  
  
  CONCLUSIONS
  The results of our study suggest that performing fluoroscopic esophagography in patients with pneumomediastinum is unnecessary when CT is negative for esophageal perforation.
authors.affiliation: 1 Department of Medical Imaging and Intervention, Division of Emergency and Critical Care Radiology, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing St, Gueishan, Taoyuan 33305, Taiwan.
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Wu
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Chen
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Chen
authors.forename: Yon-Cheong
authors.initials: YC
authors.lastname: Wong
authors.forename: Chao-Jan
authors.initials: CJ
authors.lastname: Wang
authors.forename: Wan-Chak
authors.initials: WC
authors.lastname: Lo
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D004939:Esophageal Perforation / Q000000981:diagnostic imaging* / Q000209:etiology; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007472:Iohexol; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol