J Cardiovasc Ultrasound.  2015 Sep;23(3):181-185. 10.4250/jcu.2015.23.3.181.

A Rare Case of Iatrogenic Deep Neck Infection Secondary to Hypopharyngeal Injury Caused by the Transesophageal Echocardiography

• Kim HY
• Lee SC
• Park SJ
• Choi JO
• Chang SA
• Kim SM
• Choe YH
• Oh JK
• Park SW

• KMID: 2068729
• DOI: http://doi.org/10.4250/jcu.2015.23.3.181

Abstract

Transesophageal echocardiography (TEE) is considered relatively safe but semi-invasive. The hypopharyngeal and esophageal injury is infrequent complication of TEE but could be serious, even life-threatening. We present a case of a 74-year-old man who experienced a deep neck infection secondary to hypopharyngeal injury following TEE. The diagnosis was made because of the subcutaneous emphysema developed 3 hours after TEE. In spite of antibiotics therapy with prolonged fasting, a right parapharyngeal and retropharyngeal abscess was developed 5 days later. With ultrasound-guided drainage of abscess and continuous antibiotic treatment, infection was controlled. The patent underwent mitral valve repair after 14 days of antibiotic therapy. The patient recovered uneventfully. For cardiologists performing TEE, it is required to know complications and their risk factors to minimize hypopharyngeal and esophageal injury.

Keyword

Hypopharyngeal injury; Transesophageal echocardiography; Complications; Hypopharynx; Iatrogenic deep neck infection

MeSH Terms

Abscess
Aged
Anti-Bacterial Agents
Diagnosis
Drainage
Echocardiography, Transesophageal*
Fasting
Humans
Hypopharynx
Mitral Valve
Neck*
Retropharyngeal Abscess
Risk Factors
Subcutaneous Emphysema
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Transesophageal echocardiography revealed severe eccentric mitral regurgitation with mitral valve prolapse (A3-P3 commissure).

• 

  Fig. 2 Subcutaneous emphysema was detected on initial neck X-ray (A) and resolving subcutaneous emphysema was shown on follow-up neck X-ray (B).

• 

  Fig. 3 Subcutaneous emphysema without involvement of mediastinum on initial computed tomography.

• 

  Fig. 4 Initial esophagography (A) and follow-up esophagography (B) showed no evidence of contrast leakage.

• 

  Fig. 5 Axial computed tomography (CT) (A) and coronal CT (B) showed the right parapharyngeal and retropharyngeal abscess with displacement of the larynx on follow-up neck CT.

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