2018 Volume 43 Issue 3 Pages 493-500
We previously reported two cases where patients died due to esophageal bleeding caused by catheter placement in the esophagus, which was overriding the descending aorta and then running down into the left side in association with the mediastinal deviation towards the left due to right-convex thoracic scoliosis. In this study, we further report two additional cases where we observed the similar esophageal condition without lethal bleeding. The Case 1 was a 36-year old male with metachromatic leukodystrophy. A chest CT image, which was obtained when he had aspiration, revealed that his esophagus was overriding the descending aorta at the site where the left main bronchus and the descending aorta were crossing over in association with right-convex thoracic scoliosis, and then further running down into the left side with a large curve. He had been managed with a gastric fistula and had never experienced a long-term catheter placement in the esophagus. He had no past history of esophageal bleeding. The Case 2 was a 53-year old female with cerebral palsy. She had persistent coffee-ground gastric residue during nasogastric tube-feeding. A chest CT image revealed that the esophagus, which had received catheter placement due to right-convex thoracic scoliosis as in the Case 1, was overriding the descending aorta and then running into the left side, being sandwiched between the left main bronchus and the descending aorta. Erosion and redness were observed on the esophageal mucosa with esophagoscopy, suggesting that there was esophageal bleeding caused by catheter placement.
