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      Chronic esophageal dissection: Delayed diagnosis in a 15-year-old male

      case-report

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          Abstract

          Esophageal dissection is a rare condition, characterized by disruption of the submucosa from the muscular layer of the esophageal wall. It is commonly iatrogenic in etiology and patients typically present with acute onset dysphagia, odynophagia, and retrosternal pain. The condition can be diagnosed endoscopically; however, contrast swallow studies either with CT or fluoroscopy carry less risk and are the imaging investigations of choice for this condition. Patients are managed conservatively in the majority of cases. In this case report, we present a case of chronic esophageal dissection in a 15-year-old male who had undergone endoscopic removal of a foreign body from the esophagus several years prior. We discuss the clinical features, radiological diagnosis, and management of this condition.

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          Case report; oesophageal laceration following remote trauma.

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            Circumferential intramural esophageal dissection successfully treated by endoscopic procedure and metal stent insertion.

            Spontaneous intramural esophageal dissection is a rare disorder characterized by a lengthy laceration between the mucosal and submucosal layers of the esophageal wall, without perforation. The majority of previously reported cases of spontaneous intramural esophageal dissection were partial, and the circumferential type of intramural esophageal dissection has not been reported previously. Most spontaneous intramural esophageal dissection responds to conservative management, and usually it dose not lapse into a long protracted course of dealing with sequelae. We report an unusual case of circumferential intramural esophageal dissection, in which initial conservative management failed to alleviate the patient's dysphagia, necessitating the use of several endoscopic treatments, including incision of the septum between the false and true lumens, transection of the true esophageal wall, balloon dilatation, and metal stent insertion.
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              Intramural hematoma of the esophagus: a pictorial essay.

              Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory-Weiss tear and Boerhaave's syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory-Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Computed tomography (CT) is the imaging modality of choice and characteristically reveals a concentric or eccentric thickening of the esophageal wall with well-defined borders and variable degree of obliteration of the lumen. Measurement of the attenuation values within the lesion will reveal blood density which varies according to the age of the hematoma. CT should be considered the preferred diagnostic technique, thereby facilitating proper clinical management. Early diagnosis is crucial as most patients may be treated conservatively with good outcome.
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                Author and article information

                Journal
                J Clin Imaging Sci
                J Clin Imaging Sci
                JCIS
                Journal of Clinical Imaging Science
                Scientific Scholar
                2156-7514
                2156-5597
                16 April 2022
                2022
                : 12
                : 16
                Affiliations
                [1 ]Department of Head and Neck Surgery, University College London Hospitals NHS Foundation Trust , London, United Kingdom.
                [2 ]Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust , London, United Kingdom.
                [3 ]Department of Radiology, Watford General Hospital , Watford, Hertfordshire, United Kingdom.
                Author notes
                [* ] Corresponding author: Nilesh Vakharia, Department of Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom. nilesh.vakharia@ 123456nhs.net
                Article
                10.25259/JCIS_3_2022
                10.25259/JCIS_3_2022
                9062898
                35510243
                c783688a-3bb5-4095-b32d-53ef07e8be2c
                © 2022 Published by Scientific Scholar on behalf of Journal of Clinical Imaging Science

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 04 January 2022
                : 10 March 2022
                Categories
                Neuroradiology/Head and Neck Imaging
                Case Report

                Radiology & Imaging
                esophageal dissection,dysphagia,contrast swallow,fluoroscopy
                Radiology & Imaging
                esophageal dissection, dysphagia, contrast swallow, fluoroscopy

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