Schwannoma of the cervical esophagus: Report of 2 cases and a review of the literature

September 20, 2015     Yu-Long Wang, MD; Jian-Guang Sun, MD; Jian Wang, MD; Wen-Jun Wei, MD; Yong-Xue Zhu, MD; Yu Wang, MD; Guo-Hua Sun, MD; Kuan Xu, MD; Hui Li, MD; Ling Zhang, MD; Qing-Hai Ji, MD


Schwannomas of the cervical esophagus are extremely rare, as fewer than a dozen reports have been published in the literature. Therefore, their clinical characteristics and management have not been definitively elucidated. We report 2 cases of cervical esophageal schwannoma (CES) in which the patients-a 52-year-old woman and a 53-year-old woman-were initially misdiagnosed clinically. The correct diagnosis was later established on the basis of contrast-enhanced computed tomography (CT) and intraoperative frozen-section analysis. In both cases, the tumor was enucleated, and the esophagus was closed by primary intention. Both patients resumed an oral diet 2 weeks postoperatively. Follow-up detected no evidence of recurrence. Our review of the literature revealed that CES is a benign mesenchymal tumor that can be misdiagnosed both clinically and pathologically. Preoperative contrast-enhanced CT and intraoperative frozen-section analysis help in the planning for conservative enucleation, which precludes the need for esophageal resection and its associated morbidity.

Minimally invasive drainage of a posterior mediastinal abscess through the retropharyngeal space: A report of 2 cases

March 2, 2015     Dan Lu, MD; Yu Zhao, MD, PhD


Foreign-body ingestion is a common cause of esophageal perforation, which can lead to a fatal posterior mediastinal abscess. Routine treatments include the drainage of pus through the esophageal perforation, thoracotomy, and videothoracoscopic drainage. We present 2 cases of posterior mediastinal abscess caused by esophageal perforation. Both patients-a 44-year-old woman and an 80-year-old man-were successfully treated with a novel, minimally invasive approach that involved draining pus through the retropharyngeal space; drainage was supplemented by the administration of broad-spectrum antibiotics and nasal feeding.

Adult presentation of laryngeal cleft: Utility of the modified barium swallow study in diagnosis and management

December 19, 2014     Genevieve Houdet-Cote, MHSc; Simon R. McVaugh-Smock, MHSc

We present a case of laryngeal cleft in a 41-year-old man to illustrate the co-occurrence of laryngeal cleft and tracheoesophageal fistula. We advocate the use of the modified barium swallow study in the diagnosis of laryngeal cleft. We also review the advantages and limitations of the various diagnostic methods, as well as the potential for known tracheoesophageal fistula to mask laryngeal cleft. Finally, we discuss the importance of early identification of laryngeal cleft in the context of its potentially serious health implications.

Superior omohyoid muscle flap repair of cervical esophageal perforation induced by spinal hardware

December 19, 2014     Christopher Chase Surek, DO; Douglas A. Girod, MD, FACS

Cervical esophageal perforation is a rare and life-threatening condition. Its prompt diagnosis and treatment require a high index of suspicion. Cervical spine hardware is an uncommon cause of posterior esophageal perforation. Management has included a variety of musculofascial flaps for surgical repair. We present 2 cases of cervical esophageal perforation induced by spinal hardware that were repaired with a superior omohyoid muscle (SOM) flap for closure and/or primary closure reinforcement. Advantages and techniques of the SOM flap are discussed.

Congenital airway anomaly of double aortic arch in a 2-day-old infant

October 17, 2014     Seo Moon, MD; Jessica Mayor, MD; Ramzi Younis, MD

Double aortic vascular ring is a complete vascular ring that is formed when the distal portion of the right dorsal aorta fails to regress and the ascending aorta bifurcates to surround and compress both trachea and esophagus and rejoins to form the descending aorta.

Lung herniation: An unusual cause of dysphagia

December 20, 2013     Karen Mason, MBBS, MRCS, FRCR; Richard D. Riordan, MBBS, BSC, MRCP, FRCR


Lung herniation is a rare condition that can be classified on the basis of location and etiology. We report an unusual case of right apical lung herniation presenting with dysphagia. Computed tomography of the neck demonstrated an air-containing structure in the root of the right side of the neck, related to but separate from the anteromedial aspect of the right lung apex. The diagnosis of an apical lung hernia was confirmed using high-resolution CT reconstructions. This case highlights that, although uncommon, apical lung hernias should always be considered when investigating abnormalities of swallowing. Identification of an apical lung hernia on plain chest radiographs avoids further unnecessary investigations and surgical intervention. Knowledge of their presentation may avoid complications that could arise from neck interventions such as subclavian central catheter insertion.

Autoimmune swallowing disorders

December 20, 2013     Mursalin M. Anis, MD, PhD; Ahmed M.S. Soliman, MD

Esophageal perforation in a patient with diverticulum following anterior discectomy and fusion

October 23, 2013     Aasif A. Kazi, PharmD; Nancy L. Solowski, MD; Gregory N. Postma, MD; Paul M. Weinberger, MD

 Most perforations are thought to result from esophageal retraction, direct injury during manipulation, hardware failure, or movement of cervical vertebral bodies during hyperextension.

Practical applications of in-office fiberoptic transnasal esophagoscopy in the initial evaluation of patients with squamous cell cancer of the head and neck

September 18, 2013     Robert W. Dolan, MD; Timothy D. Anderson, MD


We conducted a study to analyze the effectiveness of transnasal esophagoscopy (TNE) as an alternative to operative endoscopy (OE) for the evaluation of primary head and neck cancers and for the surveillance of synchronous esophageal cancers. Our study population was made up of 96 consecutively presenting patients-75 men and 21 women, aged 45 to 88 years (mean: 64)-who were treated at our institution for squamous cell cancer of the head and neck. Of this group, 42 patients had been evaluated with TNE and 54 with OE. More OEs were performed in patients with an unknown primary (26 vs. 3). Incidental findings on TNE included 3 cases of gastritis, 2 cases each of hiatal hernia and esophagitis, 1 case of Barrett esophagus, and 1 inlet patch. No incidental findings were reported during OE. Primary cancers were biopsied by TNE through a port on the endoscope in 4 patients; 2 of these cancers were in the tongue base, 1 in the hypopharynx, and 1 in the aryepiglottic fold. After the initial visit, patients in the TNE group waited significantly fewer days for their endoscopy than did those in the OE group (median: 6.5 vs. 16; p < 0.05). Conversely, patients in the OE group waited significantly fewer days for treatment following endoscopy (median: 12 vs. 20; p < 0.05). However, there was no significant difference between the TNE patients and the OE patients in the total number of days comprising their entire course of management, from the initial visit to definite treatment (median: 27.5 and 33 days, respectively; p = 0.7). We conclude that TNE is a reasonable alternative to OE for the initial screening for synchronous esophageal cancers in patients with squamous cancers of the head and neck. OE is preferred for the initial workup of unknown primary cancers and for large tongue base cancers. The rate of detection of clinically relevant incidental findings is higher with TNE. Biopsy is possible during TNE for all subsites within the upper aerodigestive tract.

Transnasal esophagoscopy and the diagnosis of a mediastinal foregut duplication cyst

August 21, 2013     Amarbir S. Gill, BS and Jennifer L. Long, MD, PhD

Foregut duplication cysts are true mucus-filled cysts lined with a thin epithelial layer, arising from either bronchogenic, esophageal, or neuroenteric precursor tissue.

Systemic sclerosis and reflux

April 17, 2013     John J. Petronovich, BS; Jonathan M. Bock, MD

MII-pH testing with impedance-based symptom association may improve diagnostic accuracy in patients with systemic sclerosis and reflux.

The missing tracheoesophageal puncture prosthesis: Evaluation and management

February 25, 2013     Shelby C. Leuin, MD; Daniel G. Deschler, MD


Placement of a tracheoesophageal puncture prosthesis in the post-laryngectomy patient has significantly improved voice rehabilitation in this population. Rarely, the prosthesis may become dislodged, necessitating medical evaluation. We present the case of a 61-year-old man who presented to our Emergency Department with a missing prosthesis. We describe the evaluation and management of this patient and review the relevant literature. We conclude with the following algorithm: When a patient presents with a missing prosthesis, evaluation of the tracheobronchial tree must be performed. Once the pulmonary system is cleared, the prosthesis can be presumed in the gastrointestinal tract and allowed to pass. A new prosthesis or catheter should be placed in the tract to prevent aspiration.

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