SHM Converge Scientific Abstract ePoster Gallery-Full Thickness Esophageal Perforation Due to Transesophageal Echocardiogram (Tee)

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A 68-year-old woman with a recent cryptogenic stroke and atrial fibrillation underwent an elective transesophageal echocardiogram (TEE) for evaluation of a patent foramen ovale (PFO) and possible closure. The TEE identified a PFO with right-to-left shunting. Soon afterward, she developed severe neck pain, dysphagia, dyspnea, neck and chest crepitus, and tenderness. Imaging with chest X-ray and CT showed pneumomediastinum and subcutaneous emphysema, raising concern for esophageal perforation.<br /><br />Her condition rapidly worsened, with septic shock and hemodynamic instability requiring intubation, sedation, broad-spectrum antibiotics, and vasopressor support. Urgent EGD demonstrated a complete esophageal perforation extending from the hypopharynx to the mid-esophagus. Because of the extensive injury, endoscopic repair was not possible. Cardiothoracic surgery and otorhinolaryngology performed same-day surgical debridement of the neck with drainage, without immediate esophageal closure.<br /><br />The report emphasizes that esophageal perforation is a rare but life-threatening complication of TEE, especially in patients with underlying esophageal abnormalities such as stricture, web, esophagitis, or other structural disease. Symptoms may include chest pain, dyspnea, vomiting, fever, dysphagia, and crepitus. Diagnosis can be aided by chest X-ray, CT, esophagram, laryngoscopy, or endoscopy, depending on stability. Standard management includes airway protection, antibiotics, hemodynamic support, decompression, and surgical intervention when needed.<br /><br />The case highlights the importance of early recognition of post-TEE complications. Although TEE is generally considered safe, clinicians must remain alert for perforation, particularly in patients with pre-existing dysphagia or esophageal disease, because prompt intervention can reduce morbidity and mortality.

Asset Subtitle

Huy Nong

Meta Tag

Author List Huy Nong, Michael H. Vu Md, Prashant Kedia

Category Clinical Vignettes

Concept Esophageal Injury

Concept Transesophageal Echocardiography

Concept Airway Protection

Concept Early Warning Signs

Concept Hemodynamic Instability

Distinguished Non-Finalist

Presenter Organization Methodist Dallas

Presenting Author Huy Nong

Track Adult

Keywords

transesophageal echocardiogram

esophageal perforation

pneumomediastinum

subcutaneous emphysema

atrial fibrillation

patent foramen ovale

septic shock

dysphagia

mediastinitis

surgical debridement

Esophageal Injury

Transesophageal Echocardiography

Airway Protection

Early Warning Signs

Hemodynamic Instability