CT can play a primary and complementary role in the diagnosis and evaluation of esophageal emergencies, which can result in significant morbidity and mortality if not recognized and treated promptly.

In an article in the October monograph issue of RadioGraphics (RSNA.org/radiographics), Catherine A. Young, M.D., of the Mallinckrodt Institute of Radiology in St. Louis, and colleagues identify the esophageal conditions that may manifest emergently. Also addressed are the clinical and CT manifestations of common esophageal emergencies and the utility of CT in the evaluation of acute esophageal disease.

Aortoesophageal fistula in a middle-aged man with a history of erosive esophagitis and chest pain initially thought to have a cardiac origin.

(a) Axial contrast-enhanced CT image obtained with an aortic dissection protocol shows mediastinitis and a large gas-containing abscess (A) directly abutting the aorta. The wall of the proximal descending aorta is irregular, giving rise to small projections of contrast material (arrowheads), findings suggestive of an aortoesophageal fistula. (b) Coronal reformatted CT image from the same study as a nicely depicts the long interface between the two lumina, with total obliteration of the intervening fat plane (arrowheads). These findings and the history of hematemesis are indicative of an aortoesophageal fistula. The diagnosis was confirmed at endovascular treatment and subsequent surgery.

The 2008 RadioGraphics monograph issue focuses on emergency
radiology.

Specifically, Dr. Young and colleagues address:

• Esophagitis

• Foreign body impaction

• Trauma

• Mallory-Weiss tear and other mucosal lacerations

• Intramural dissection and hematoma

• Transmural perforation

"An awareness of the CT findings associated with the spectrum of acute esophageal disease will promote the radiologist's ability to accurately diagnose esophageal emergencies, thereby reducing delays in diagnosis that are likely to have a negative effect on outcomes," the authors conclude.

This article meets the criteria for 1.0 AMA PRA Category 1 Credit™.

Abdominal Wall CT Angiography: A Detailed Account of a Newly Established Preoperative Imaging Technique

Autologous surgical breast recon- struction with use of abdominal wall donor flaps based on the deep inferior epigastric artery (DIEA) and one or more of its anterior musculocutaneous perforating branches (DIEA perforator flap) is being used with increasing frequency. Using abdominal wall CT angiography to preoperatively map the DIEA perforators provides the surgeon with information that can optimize the surgical technique, shorten procedure time and reduce surgical complications.

In a How I Do It article in the October issue of Radiology (RSNA.org/radiology), Timothy J. Phillips, M.B.B.S., of The Royal Melbourne Hospital in Victoria, Australia, and colleagues outline use of abdominal wall CT angiography in these cases, noting that they require a novel approach differing substantially from typical abdominal CT angiographic techniques.

Axial 50-mm section thickness maximum intensity projection (MIP) image obtained with abdominal wall CT angiography shows the labeled segments of a perforator originating from the right DIEA.

Addressed by Dr. Phillips and colleagues:

• Appropriate patient selection

• Contrast material enhancement

• Image acquisition and reconstruction parameters

• Image display and analysis techniques

• Presentation of data to the referring surgeon

The authors also explain the surgical and radiologic anatomy of the DIEA and the characteristics that define favorable perforators.

"These recommendations are based on the authors' experience in performing and interpreting the results of 65 abdominal wall CT angiographic examinations and on close collaboration between the departments of radiology and plastic surgery at our institution," the authors write.