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case_images: Imaging findings for a male in his mid-70s who presented with a 2-h history of severe sudden onset chest pain preceded by vomiting after a large meal: (a) enhanced chest computed tomography (CT) showed a focal wall defect of the upper thoracic oesophageal wall (arrow) at the level of the first thoracic vertebra (T1) with the middle mediastinal air-fluid collection, suggesting oesophageal perforation (asterisk); (b) chest CT, obtained at a different level, revealed a large hematoma surrounding the collapsed oesophagus in the middle mediastinum with internal extravasation of contrast medium, suggesting active bleeding and (c) selective right bronchial artery angiography confirmed a pseudoaneurysm (arrow) in an oesophageal artery that had an anastomotic branch with the bronchial artery.
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case_images: Enhanced chest computed tomography (CT) revealed a focal wall defect of the upper thoracic oesophageal wall at the level of the first thoracic vertebra (T1) with middle mediastinal air-fluid collection, suggesting oesophageal perforation (Figure 1(a)), while the chest CT, obtained at a different level, also revealed a large haematoma surrounding the collapsed oesophagus in the middle mediastinum with internal extravasation of contrast medium, suggesting active bleeding (Figure 1(b)). Selective right bronchial artery angiography using a 5 Fr cobra catheter (Cook Medical Inc, Bloomington, IN, USA) confirmed a pseudoaneurysm in an oesophageal artery that had an anastomotic branch with the bronchial artery (Figure 1(c)).
case_images: Imaging findings for a male in his mid-70s who presented with a 2-h history of severe sudden onset chest pain preceded by vomiting after a large meal: (a) a follow-up computed tomography scan revealed residual active bleeding within the previous haemomediastinum and (b) superselective angiography of the inferior thyroidal artery with microcatheter showed extravasation of contrast media (thick arrow) from the oesophageal artery arising from the descending branch of the inferior thyroidal artery (thin arrow).
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case_images: A follow-up CT scan revealed residual active bleeding within the previous haemomediastinum (Figure 2(a)). Selective angiography of the ITA showed extravasation of contrast media from the oesophageal artery arising from the descending branch of the ITA (Figure 2(b)).
case_images: Imaging findings for a male in his mid-70s who presented with a 2-h history of severe sudden onset chest pain preceded by vomiting after a large meal: (a) contrast oesophagogram showed an intrathoracic extra-oesophageal leak of the contrast (arrow) into the mediastinum from the right aspect of the upper third of the oesophagus and (b) emergent oesophagogastroduodenoscopy was performed, which revealed a huge tear (arrow) at the right lateral aspect of the proximal oesophagus from 20 cm to 27 cm from the incisor. The colour version of this figure is available at: http://imr.sagepub.com.
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case_images: Contrast oesophagogram after TAE showed an intrathoracic extra-oesophageal leak of the contrast into the mediastinum from the right aspect of the upper third of the oesophagus (Figure 3(a)). This examination revealed a huge tear at the right lateral aspect of the proximal oesophagus, approximately 20 cm from the incisor and a haematoma (Figure 3(b)) that was successfully controlled by a full-coverage oesophageal stent.
case_images: PMC11800261_02