Intramural Esophageal Abscess Complicated with Pleural Fistula: A Case Report

Abstract

Intramural esophageal abscess is a rare entity caused by mucosal injury to the esophagus but without transmural perforation. The mucosal disruption provides access to the intraluminal infectious contents to traverse into the loose submucosal tissue, resulting in an intramural abscess. It is important to be well-versed in the clinical and imaging findings of this pathology in order to make a timely diagnosis. Here, we present a case of intramural esophageal abscess complicated with a pleural fistula with a focus on the radiological features of this rare entity. To our knowledge, this is the first time that an esophageal intramural abscess complicated with pleural fistula is discussed in peer-reviewed literature.

Keywords: computed tomography; contrast esophagography; double barreled esophagus; intramural esophageal abscess; intramural esophageal dissection; pleural fistula.

Figure 1. CT of the chest after vancomycin IV treatment

CT with contrast axial (Fig: 1A) and coronal (Fig: 1B) reconstruction demonstrates intramural esophageal abscess with tiny gas locules (yellow arrow) displacing the enteric tube anteriorly (red arrow) CT: computed tomography; IV: intravenous

Figure 2. CT of the chest after incision and drainage of the abscess

CT with contrast axial (Fig: 2A) and coronal (Fig: 2B) reconstruction demonstrates orally administered barium contrast in the right apical pleural space (yellow arrow) and decrease in size of intramural esophageal abscess (red arrow) consistent with esophageal pleural fistula CT: computed tomography