The Additional Value of Esophageal Wall Evaluation and Secondary Findings in Emergency Patients Undergoing CT Pulmonary Angiography

A significant proportion of patients with chest discomfort suffer from esophageal pathology and other conditions unrelated to pulmonary embolism.
To determine the proportion of emergency patients undergoing CT pulmonary angiography, where esophageal pathology suspected from CT and other secondary findings would contribute to the explanation of their symptoms.
Patients and CT scans of 434 patients who were referred from the emergency department for CT pulmonary angiography were evaluated for esophageal wall thickness and distention, the presence of pulmonary embolism and other findings that might explain acute symptoms. Esophageal pathology was considered when the distal esophageal wall was at least 5 mm thick, as previously reported.
Pulmonary embolism was confirmed in 27% patients. The distal esophageal wall was thickened in 87 (20%) patients. In this group, pulmonary embolism was present in 11 patients (13%) compared to 104 (30%) in patients without esophageal wall thickening (P = 0.007). From 76 patients with excluded pulmonary embolism, in 43 (56%), a suspected esophageal pathology was consistent with their symptoms. Gastroscopy confirmed CT findings in 34 of 42 patients (P = 0.0001).
Esophageal wall thickening is common in emergency patients with excluded pulmonary embolism and this finding may help to direct the patients appropriately.