Imaging findings of iatrogenic pharyngeal and esophageal injuries in neonates

Abstract

Iatrogenic injuries to the upper gastrointestinal tract in neonates are rare but may lead to significant morbidity and mortality if undiagnosed. The clinical presentation of such injuries is usually nonspecific and symptoms may be overlooked, particularly in sick preterm neonates. Therefore, it is important to recognize the findings on plain chest radiographs obtained regularly in neonatal intensive care units (NICUs) on intubated patients. The purpose of this pictorial essay is to describe the imaging findings of various iatrogenic injuries to the pharynx and esophagus in the neonatal period in a cohort of seven cases.

Esophageal perforation with orogastric tube malposition in low‐birth‐weight infant

“…Although there are several typical findings suggesting esophageal perforation in newborn, findings of this case are rare and the most difficult to diagnose radiographically. 2 Physicians should suspect the malposition of the gastric tube when there is a straight course of the lower segment of the tube, and lateral chest radiograph could be useful for confirming the position of tip.…”

Bedside Ultrasonography in Evaluating Mediastinum Leakage in an Extremely-Low-Birth-Weight Infant with Esophageal Perforation

“…Hence, plain radiography and contrast esophagography have been utilized in the diagnosis of esophageal perforation in preterm neonates. 7 The important findings in plain radiography are abnormal positions of gastric tubes and air leakage. 7 Contrast esophagography is also useful in differentiating esophageal atresia from esophageal wall injury with a false lumen.…”

“… 7 The important findings in plain radiography are abnormal positions of gastric tubes and air leakage. 7 Contrast esophagography is also useful in differentiating esophageal atresia from esophageal wall injury with a false lumen. 7 However, both imaging methods were unable to provide information on the extent of fluid collection in the mediastinum.…”

“… 7 Contrast esophagography is also useful in differentiating esophageal atresia from esophageal wall injury with a false lumen. 7 However, both imaging methods were unable to provide information on the extent of fluid collection in the mediastinum. Further, they are not useful in detecting the development of mediastinal abscess, which is one of the most serious complications of esophageal perforation.…”

“…Further, they are not useful in detecting the development of mediastinal abscess, which is one of the most serious complications of esophageal perforation. 8 Although nonoperative conservative management has consistently shown satisfactory prognosis in several case series of neonatal esophageal perforation, 3 7 9 10 11 surgical interventions are required when the abscess is formed within the mediastinum. 7 12 13 …”