chembree
Guru
How would you code the below procedue?
Report
Indication: Long history of Zollinger-Ellison syndrome, gastrinomas, status post multiple surgeries presenting with inability to swallow, pneumonia right lower lobe and with pneumomediastinum.
Technique: Orally a 5 French catheter and Glidewire were placed to traverse into the proximal esophagus. Glidewire and KMP catheter could not be passed beyond the proximal third level of the thoracic esophagus. Dilute Gastrografin was then slowly infused through the catheter with hand injection outlining the proximal thoracic esophagus to be slightly dilated. There is tapering of the lumen significantly at the level of the carina to the level of abrupt complete obstruction. Contrast is seen to pass fluoroscopically on into right lower lobe bronchi representing esophageal bronchial fistula. No contrast reaches the stomach. Patient did not aspirate.
Fluoroscopic time: Approximately 1 minute.
Impression: Thoracic esophagus is not patent. There is obstruction at the level of the carina with tapering of the esophageal lumen. Contrast delivered within the proximal esophagus traverses into the right lower lobe bronchi representing an esophageal tracheal or esophageal bronchial fistula. This would explain the mid mediastinum seen on recent CT scan.
Report
Indication: Long history of Zollinger-Ellison syndrome, gastrinomas, status post multiple surgeries presenting with inability to swallow, pneumonia right lower lobe and with pneumomediastinum.
Technique: Orally a 5 French catheter and Glidewire were placed to traverse into the proximal esophagus. Glidewire and KMP catheter could not be passed beyond the proximal third level of the thoracic esophagus. Dilute Gastrografin was then slowly infused through the catheter with hand injection outlining the proximal thoracic esophagus to be slightly dilated. There is tapering of the lumen significantly at the level of the carina to the level of abrupt complete obstruction. Contrast is seen to pass fluoroscopically on into right lower lobe bronchi representing esophageal bronchial fistula. No contrast reaches the stomach. Patient did not aspirate.
Fluoroscopic time: Approximately 1 minute.
Impression: Thoracic esophagus is not patent. There is obstruction at the level of the carina with tapering of the esophageal lumen. Contrast delivered within the proximal esophagus traverses into the right lower lobe bronchi representing an esophageal tracheal or esophageal bronchial fistula. This would explain the mid mediastinum seen on recent CT scan.
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