CTICasesCarotid Artery Erosion into a Gastric Conduit
Imaging findings
A patient with prior esophagectomy for squamous cell carcinoma developed biopsy-proven mediastinal recurrence around a vessel and presented with hematemesis and anemia. CT shows high-attenuation material and food within the gastric conduit and soft tissue surrounding the carotid artery with subtle wall irregularity, without active extravasation initially. With recurrent bleeding, angiography showed contrast from the internal carotid forming an eddy into the conduit at the site of endoscopic clips, and a covered stent was placed.
Key takeaways
Recurrent esophageal squamous cell carcinoma in the mediastinum can erode into an adjacent artery (here the carotid) and fistulize into the gastric conduit, causing upper GI hemorrhage. Subtle arterial wall irregularity adjacent to tumor should raise concern even without active extravasation, and the arterial-to-conduit communication can be treated with a covered stent; such arterial erosion (rather than the more common occlusion) is unusual in the chest.
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