CTICasesIatrogenic Esophageal Perforation and Mediastinal Hematoma secondary to Enteric Tube Malposition
Imaging findings
A frontal chest radiograph demonstrates an enteric tube with an abnormal course, tracking too far to the left of the midline spine. Contrast-enhanced CT confirms that the tube has perforated the hypopharynx or upper esophagus, running extra-luminally down the neck and posterior mediastinum. High-resolution CT shows a large mediastinal hematoma, extra-esophageal air, and surrounding soft tissue edema.
Key takeaways
Iatrogenic esophageal or pharyngeal perforation is a serious risk of enteric tube placement, particularly in obtunded, critically ill, or sedated patients who cannot communicate pain. The use of a stiffening stylet during insertion provides sufficient rigidity to inadvertently puncture the pharyngeal or esophageal wall. Radiologists must maintain a high index of suspicion and carefully evaluate the complete path of enteric tubes on radiographs; any lateral deviation or unusual course relative to the trachea and esophagus warrants urgent CT evaluation.
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