Perforation of the hypopharynx after transesophageal echocardiography.
A 65-year-old obese woman with an oversized neck and dysphagia underwent transesophageal echocardiography (TEE). The procedure was complicated by difficulty in insertion from the pharynx to esophagus, and her head and neck gradually swelled. Computed tomography (CT) revealed extensive emphysema from the neck to superior mediastinum, which suggested pharyngeal perforation. A nasogastric tube was inserted, and the patient received antibiotics to prevent secondary mediastinitis. CT performed 1 week later showed improvement of emphysema and no evidence of mediastinitis. Perforation along the orogastric pathway during TEE is a rare but life-threatening complication to which physicians performing TEE should pay attention.
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan. ohnishi-t@kkr.hiratsuka.kanagawa.jp.
Takayuki
T
Onishi
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Yuko
Y
Onishi
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Keiko
K
Tachibana
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Kensuke
K
Kasano
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Shoko
S
Hachiya
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Hirotaka
H
Muramoto
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Koji
K
Higuchi
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Atsushi
A
Suzuki
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Isshi
I
Kobayashi
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Shigeo
S
Umezawa
Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Japan.
Akihiro
A
Niwa
Complication; Mediastinal emphysema; Pharynx perforation; Transesophageal echocardiography