CTICasesTraumatic Esophageal Laceration from a Vertebral Osteophyte after Motorcycle Trauma
Imaging findings
A motorcyclist struck and dragged by a vehicle had CT showing abnormal soft-tissue opacity anterior and bilateral to the upper thoracic spine with effacement of the adjacent fat, centered at a disc level with associated disc space widening; a sliver of gas was noted just behind the trachea. MRI obtained subsequently showed florid injury extending from anterior to posterior through that disc space, though the patient remained neurologically intact. An esophagram obtained about a week later, after the patient returned with esophageal symptoms, showed a transmural laceration of the entire esophagus directly opposite the injured disc space, with contrast extravasating on both sides.
Key takeaways
A sharp, flowing anterior osteophyte at a rigid, DISH-affected spinal segment can act like a blade during a high-energy distraction/deceleration injury, lacerating the adjacent esophagus at the level of vertebral injury even in the absence of paraplegia or an obvious initial esophageal finding; a widened disc space with anterior soft-tissue abnormality on the index trauma CT should prompt consideration of an occult esophageal injury, which may not become clinically or radiographically apparent (via esophagram) until days later.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Thoracic Spine Fracture through a Disc Space in Diffuse Idiopathic Skeletal Hyperostosis (DISH)Trauma
- Radiation-Induced Organizing Pneumonia after Breast Cancer RadiotherapyILD
- Invasive Pulmonary and Cerebral Aspergillosis Mimicking a GPA FlareInfection
- Calcified Carcinoid TumorNeoplastic
- Idiopathic Pleuroparenchymal Fibroelastosis (PPFE) with Mixed NSIP/Organizing Pneumonia FeaturesILD
- Acute Viral Myocarditis with Cardiogenic ShockInfection
- Intravascular Pulmonary Metastases (Tumor Emboli) from Bladder CancerNeoplastic
- Lepidic-Pattern Pulmonary Metastases from Cholangiocarcinoma (Biliary Tract Cancer)Neoplastic
See all cases from July 27, 2018 →
Related Trauma cases
- Post-Traumatic Diaphragmatic Hernia with Fat Herniation
- Retained Wooden Foreign Body ("Timber Thorax")
- Blunt Traumatic Aortic Injury with Multifocal Thoracic and Abdominal Involvement
- Incarcerated Traumatic Diaphragmatic Hernia from a Remote Stab Wound
- Delayed Presentation of Traumatic Diaphragmatic Hernia (Dependent Viscera Sign)
- Fat Embolism Syndrome after Long-Bone Trauma