CTICasesChronic Bronchopulmonary Aspiration due to Esophageal Dysmotility
Imaging findings
Serial chest radiographs spanning several years each showed a subtle air-containing structure adjacent to the trachea, representing a dilated, air-filled esophagus; a later radiograph additionally showed an abnormal interface in the azygoesophageal recess from esophageal dilation with retained food and fluid. CT performed years apart confirmed a markedly dilated, fluid- and debris-filled esophagus along with diffuse lung disease from top to bottom: multifocal consolidation, ground-glass opacity along the bronchovascular bundles, and tree-in-bud bronchiolar opacities consistent with recurrent aspiration. The findings were present on every study over several years but were not recognized or reported until very recently.
Key takeaways
A persistently dilated, air- or fluid-filled esophagus adjacent to the trachea on chest radiographs, especially when present on multiple studies over years, should raise suspicion for esophageal dysmotility or outlet obstruction (in this patient, likely from an overly tight adjustable gastric band) causing chronic, unrecognized bronchopulmonary aspiration. Because this subtle finding can be overlooked on both radiographs and CT, and patients may be followed by multiple providers without anyone synthesizing the full picture, years of morbidity from recurrent aspiration can go undiagnosed.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Aortic Dissection with Intimal Intussusception into the Left VentricleVascular
- IVC Lipoma with Fat Embolization during Attempted Percutaneous RetrievalIatrogenic
- Cardiac (Myocardial) B-Cell Lymphoma Mimicking Hypertrophic CardiomyopathyNeoplastic
- Traumatic Aortic Injury of the Ascending Aorta (Atypical Location)Trauma
- Right Ventricular Rupture from Cardiopulmonary ResuscitationIatrogenic
- Type A Aortic Dissection with Contrast Extravasation and Apical CapVascular
- Intrapulmonary Lymph Node Mimicking a Solitary Pulmonary NoduleArtifact
- Endobronchial Mucous Gland Adenoma with Obstructive Atelectasis and Pneumothorax Ex VacuoNeoplastic
See all cases from August 9, 2018 →
Related Inflammatory cases
- Fatal Reexpansion Pulmonary Edema with Contralateral ARDS
- Allergic Bronchopulmonary Aspergillosis with Bronchocentric Granulomatosis
- Localized (Unilobar) Allergic Bronchopulmonary Aspergillosis
- Acute Flare of Chronic Eosinophilic Pneumonia
- Peri-myocarditis Following PFO Closure Device Removal
- Fibrosing Mediastinitis with Right Pulmonary Artery and Vein Encasement