Joseph Chapman, DO1, Crystal Erickson, MD2, Charles Ruzkowski, MD1; 1Parkview Medical Center, Pueblo, CO; 2Kaiser Permanente Medical Center, Colorado Springs, CO
Introduction: Esophageal perforation secondary to mediastinal tuberculosis is a rarely documented medical occurrence. We describe a patient admitted with sudden onset chest pain, followed by hematemesis, who was found to have a spontaneous esophageal perforation with mediastinal aspirates growing Mycobacterium tuberculosis (TB).
Methods: A 53 year old male with past medical history of atrial fibrillation on long term anticoagulation presented to the emergency department with sudden onset chest pain. His chest pain was followed by sudden hematemesis. Chest computed tomography (CT) revealed extensive pneumomediastinum consistent with esophageal perforation with mediastinal lymphadenopathy (Figure 1). Barium esophagram confirmed evidence of a large distal esophageal perforation (Figure 2). The patient underwent emergent esophageal stent placement and open repair of perforation. There was no reported evidence of mediastinal granuloma or fistula leading to the esophagus at the level of perforation. Mediastinal fluid cultures later returned positive for Mycobacterium tuberculosis. Discussion: Esophageal perforation confers a high mortality risk to affected patients. Therefore, swift diagnosis and identification of underlying cause is important. We present a case of esophageal perforation thought to be secondary to tuberculosis induced mediastinal lymphadenopathy (1,2). It is believed that over time, persistent lymphadenopathy erodes though the esophageal wall leading to perforation. Though esophageal complications are only present in 0.15% of patient with active tuberculosis, it is important to identify tuberculosis as a potential cause of spontaneous perforation in at risk populations (3). Failure to confirm this diagnosis may lead to inadequate treatment and exposure to staff and community.
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Figure 1. CT revealing mediastinal perforation with free air surrounding esophagus (arrow).
Disclosures: Joseph Chapman indicated no relevant financial relationships. Crystal Erickson indicated no relevant financial relationships. Charles Ruzkowski indicated no relevant financial relationships.