CT Esophagography
(updated 11/17/2021, last reviewed 02/10/2022)
(updated 11/17/2021, last reviewed 02/10/2022)
INDICATIONS: Esophageal perforation, leak, stent eval
EXAM: CT chest without contrast
SERIES:
- PRE oral contrast:
- 3 mm axial angle of mandible through stomach
- POST oral contrast SUPINE:
- 0.63 mm axial angle of mandible through stomach
- 3 mm axial soft tissue
- 3 mm coronal soft tissue
- 3 mm sagittal soft tissue
- 3 mm axial lung
- 3 mm coronal lung
- Coronal slab MIP lung
- POST oral contrast PRONE:
- 0.63 mm axial angle of mandible through stomach
INSTRUCTIONS:
- Add 100 mL Isovue 370 to an 8 oz cup and fill remainder of cup with water
- Add 2 tbsp thickener and 1 pack crystal light, mix
- Obtain noncontrast (pre oral contrast) supine images.
- Patient sits up and drinks 4 oz of premixed oral contrast solution
- Patient lies back down in same position as precontrast imaging
- Patient turns head and drinks remaining 4 oz contrast through straw
- Immediately obtain postcontrast images
- If images are limited due to motion or inadequate esophageal distention, repeat the protocol
- If images are adequate, repeat with the patient prone if the patient can tolerate it
NOTES:
Literature supports the use of CT for evaluation of esophageal emergencies, citing the following reasons:
- CT esophagography is more accurate than fluoroscopy
- CT esophagography has a sensitivity of 59%–100% and a specificity of 80%–100% in assessing leak
- Fluoroscopic esophagography has a high rate of false-negative examinations, with 10%–12% of perforations missed with barium contrast material and 22%–50% missed with water-soluble contrast material
- Allows visualization of periesophageal air
- Better in critically ill patients who cannot position
- Time savings due to immediate CT availability, avoids delays
- Ability to diagnose additional pathology in an all-in-one exam
- No risk of aspiration of hypertonic solution causing pulmonary edema
- No risk of barium aspiration which can cause pulmonary inflammation
- Barium may impede subsequent endoscopy
- Fluoroscopic studies are operator dependent and require an experienced radiologist to perform and interpret the study, whereas performance and interpretation of CT esophagography is more consistent