title: Learning the hard way: when a CT scan misleads your diagnosis.
abstract: Oesophageal injury due to blunt trauma is extremely rare, and when it presents it carries a very high mortality. Time is of essence and if not promptly recognised these injuries could have devastating consequences. We report a case emphasising the importance of oesophagoscopy in diagnosing oesophageal injuries. A young man presented to our emergency ward as an unwitnessed road traffic accident after receiving first aid from a secondary care facility. At presentation, he was haemodynamically stable with decreased power in lower limbs, and with severe neck and back pain. There was high suspicion of spinal injury, which was later evident on clinical and on radiological findings. A CT scan revealed oesophageal injury, indicated by contrast extravasation, which was convincing enough to proceed without endoscopy. Surprisingly, the apparently convincing injury picked up on CT scan marked by contrast extravasation turned out to be an artefact, which led to a negative surgical exploration.
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
authors.forename: Roger Christopher
authors.initials: RC
authors.lastname: Gill
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
authors.forename: Fatima
authors.initials: F
authors.lastname: Mannan
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
authors.forename: Amber
authors.initials: A
authors.lastname: Bawa
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D016477:Artifacts; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology; D006801:Humans; D008297:Male; D010808:Physical Examination; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000473:pathology