What is the role of contrast radiography studies in the workup of pneumomediastinum (PM)?

Updated: Feb 26, 2019
  • Author: Patrick L Carolan, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Contrast studies have been recommended when esophageal perforation is suspected in some patients with PM.

Wu et al (2013) compared chest CT to contrast fluoroscopic esophagogram among patients with pneumomediastinum evident on CT who were referred for an emergent contrast study. [36] A positive result for esophageal perforation on CT was defined as evidence of esophageal injury or periesophageal infiltration that coexisted with periesophageal air. A positive fluoroscopic study result was defined as oral contrast medium leakage from the esophagus. The sensitivity and negative predictive value (NPV) were 100% for CT compared with fluoroscopic contrast esophagogram. Thus, the sensitivity and NPV of CT were either superior or equal to those of fluoroscopic esophagography for identifying esophageal perforation. These study results suggest that contrast esophagograms are unnecessary in patients with pneumomediastinum when CT is negative for esophageal perforation.

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