J Korean Soc Radiol.  2018 Jul;79(1):45-49. 10.3348/jksr.2018.79.1.45.

Acute Phlegmonous Esophagitis with Mediastinitis Complicated by an Esophageal Perforation: A Case Report

• Shin HS
• Kim SS
• Kim JH

• KMID: 2416405
• DOI: http://doi.org/10.3348/jksr.2018.79.1.45

Abstract

Phlegmonous esophagitis, a rare and life-threatening disorder, is characterized by bacterial infection of the submucosal and muscularis layers of the esophagus. Herein we report a case of acute phlegmonous esophagitis with mediastinitis complicated by an esophageal perforation in a patient with diabetes mellitus and alcoholic liver cirrhosis.

MeSH Terms

Bacterial Infections
Cellulitis*
Diabetes Mellitus
Esophageal Perforation*
Esophagitis*
Esophagus
Humans
Liver Cirrhosis, Alcoholic
Mediastinitis*

Figure

• 

  Fig. 1 A 56-year-old man with a 2-month history of fever and pain in the pharynx, chest, and abdomen. A. Axial contrast-enhanced CT image shows diffuse esophageal wall thickening with circumferential, intramural, low attenuation area surrounded by an enhanced peripheral rim (arrow). B. Sagittal reformatted contrast-enhanced CT image shows a diffuse esophageal wall thickening with circumferential, intramural, low attenuation area surrounded by an enhanced peripheral rim (arrows). C. Coronal reformatted contrast-enhanced CT image shows increased attenuation of mediastinal fat and mediastinal fluid collection along the entire esophagus (arrows). D. A gross esophagectomy specimen shows esophageal perforation of 2 cm in diameter (long arrow) located at the mid portion of the specimen. There is a diffuse loss of mucosal folds and dark-brown discoloration of the mucosa (short arrow). E. Microscopic examination shows intact esophageal squamous epithelium (arrows) and damaged muscularis layer with abundant inflammatory cells (arrowheads) (H&E, × 1.25). F. There are many lymphocytes (arrows), neutrophil (arrowhead), and necrotic inflammatory cell debri (N), which are suggestive of an abscess in the muscularis layer of the esophagus (H&E, × 200). CT = computed tomography, H&E = hematoxylin and eosin staining

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