title: Diagnostic performance of CT esophagography in patients with suspected esophageal rupture.
abstract: Esophageal rupture is a surgical catastrophe. The gold standard for diagnosing is iodine, water-soluble contrast medium esophagography. CT esophagography has shown promising results. This study aimed to assess the diagnostic performance of CT esophagography in patients with a suspicion of esophageal rupture. This prospective study assessed the performance of a diagnostic test and was approved by local IRB committee. Patients who presented with a clinical suspicion of esophageal rupture were included. CT esophagography findings were described by the emergency radiologist. Clinical outcomes (presence or absence of esophageal rupture) were reported by surgeons. The operative characteristics were calculated. A final predictive scale for rupture was built. A total of 64 patients were recruited (age 26.5 years, 90 % male, 82 % trauma). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were 77.7 % (95 % confidence interval (CI) 45-100), 94.3 % (87.2-100), 14 (9.81-19.9), and 0.24 (0.05-1.22), respectively. The final model for predicting rupture included five variables: age (odds ratio (OR) 1.03; 95 % CI, 0.95-1.11; p=0.04), leakage of contrast media into the mediastinum or pleural space (OR 10.0; 95 % CI, 0.64-156.9; p=0.10), extraluminal air or fluid collections (OR 43.1; 95 % CI, 1.52-1217.3; p=0.027), esophageal wall thickening (OR 10.1; 95 % CI, 0.50-202.8; p=0.12), and left pneumothorax or pleural effusion (OR 6.5; 95 % CI, 0.31-132.7; p=0.2). The overall agreement was 0.40 (95 % CI, 0.09-0.72) for the predictive model. The model sensitivity was 50.0 %, and the specificity was 98.4 %. CT esophagography shows a good diagnostic performance in patients with a suspected esophageal rupture.
authors.affiliation: Department of Radiology, Universidad de Antioquia-Hospital San Vicente Fundacion, Calle 64 No. 51 D-154, Medellin, Colombia, tatisuarez@hotmail.com.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Suarez-Poveda
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Morales-Uribe
authors.forename: Alvaro
authors.initials: A
authors.lastname: Sanabria
authors.forename: Adriana
authors.initials: A
authors.lastname: Llano-Sánchez
authors.forename: Andrés Mauricio
authors.initials: AM
authors.lastname: Valencia-Delgado
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Rivera-Velázquez
authors.forename: John Fernando
authors.initials: JF
authors.lastname: Bedoya-Ospina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012421:Rupture / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
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