Exploring Esophageal Widening in Computed Tomography Performed in Critically Ill Patients

Background/Objectives: Early diagnosis and therapy stratification represent central factors in the management of critically ill patients, today often assisted by clinical scores, which also include laboratory testing results. The aim of this study was to further characterize computed tomography-detected abnormal esophageal widening, which we often observe in critically ill patients in our emergency department when reading CT examinations. We expect this factor to be potentially meaningful for clinical evaluation and prognosis of critically ill patients. Methods: In this retrospective observational study, critically ill patients receiving CT trauma room imaging in our hospital’s emergency department were included. In the first part of the analysis, esophageal diameter at four anatomical landmarks were compared between patients who survived and those who died within 28 days in all critically ill patients presenting with AEW. In the second exploratory part of the study, the relevance of the laboratory parameters and AEW in predicting mortality were analyzed. In part three, the correlation between the 28-day mortality of all critically ill patients and the presence of esophageal widening was assessed. Results: Esophageal widening was detected in 98 of all 1683 included patient examinations. Nineteen of these patients have died (19.4%), and ten of them (52.6%) suffered primarily from a cerebrovascular event. In the group of patients with AEW, cervical AEW was more frequent among deceased patients (63.2% vs. 27.8%; p = 0.0064), and mean maximal esophageal diameter was also greater among deceased patients (19.2 vs. 16.4 mm; p = 0.0392). Multiple laboratory parameters were also found to correlate with mortality in all patients with AEW. No significant correlation of AEW alone with 28-day mortality in all critically ill patients that received ED-CT could be demonstrated in our retrospective sample. Conclusions: Esophageal widening, especially in the upper segment, was found in a substantial proportion of critically ill patients, with increased width correlating with mortality risk in the group of patients with AEW. Future studies should include much larger patient cohorts and a prospective design to evaluate if AEW might be a candidate to serve as a potential parameter of clinical scores which aim at early patient stratification.