Acute epiglottitis with intramural oesophageal dissection

Description

A woman aged 31 years with no medical history was admitted to the intensive care unit for acute epiglottitis. For 4 days, she had been complaining of fever, intractable vomiting and increasing cervical pain treated with anti-inflammatory drugs.

The admission CT scan confirmed the diagnosis of acute epiglottitis associated with a parapharyngeal abscess (figure 1A). An intramural oesophageal dissection (IOD) was incidentally diagnosed (figure 1B), extending from the upper oesophageal sphincter to the lesser gastric curvature without any sign of mediastinitis (figure 1C and D). Initial panendoscopy revealed mucosal necrosis on the cervical oesophagus. Neither endoscopy nor an oral contrast-enhanced CT scan revealed any perforation. The parapharyngeal abscess was surgically drained and bacteriological culture revealed Streptococcus anginosus and anaerobic bacteria. A conservative treatment of the oesophagus proved effective with invasive mechanical ventilation, parenteral nutrition and appropriate antibiotherapy for 15 days. The patient...

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