心血管手術中使用經食道超音波因不尋常鈣化淋巴結造成食道穿孔的併發症

Unusual Cause of Esophageal Perforation during Intraoperative Transesophageal Echocardiography Monitoring for Cardiac Surgery-- A Case Report

食道穿孔在使用經食道超音波監測所造成的併發症中是非常少見的，但是此致命的併發症還是有可能會發生。在此我們報告一例在心臟手術中使用經食道超音波監測而四天後發現因不尋常鈣化淋巴結造成食道穿孔的併發症。其發生的主要原因是病人縱膈腔中有一大鈣化淋巴結，且手術中使用經食道超音波造成食道被扭曲壓迫所導致。在此我們建議手術之前的放射線診斷是非常重要，尤其在病人胸部X光有發現鈣化淋巴結時。這樣才能預防類似的悲劇再次發生。

Although esophageal perforation after transesophageal echocardiographic (TEE) examination is rare yet the occurrence of this life-threatening complication is increasing. We report an unusual esophageal perforation occurring 4 days after coronary artery bypass graft surgery and Bentall's procedure. The perforation was due to inadvertent injury of the esophagus that was deformed and distorted by a large calcified lymph node in the mediastinum during intraoperative TEE instrumentation. We suggest that careful preoperative radiological examination of the mediastinum should be done to recognize the anatomical pathology in patient whose routine chest X-ray has disclosed a large calcified lymph node in the mediastinum, if he happens to undergo TEE, so as to avoid disastrous esophageal perforation.