Case Presentation
A 49-year-old female with a past medical history significant for depression, schizophrenia, and nicotine abuse presented with progressive sore throat and dysphagia for 5 days. Imaging showed a retropharyngeal fluid collection (Figure 1). She underwent direct laryngoscopy and cervical esophagoscopy. A sickle knife was used to make an incision in the posterior pharyngeal wall, but no significant amount of purulence was released. She was maintained on intravenous antibiotics. She was discharged 2 days later. Three days after her procedure, she was presented again to the emergency department with increased neck and throat pain. A computed tomography (CT) scan showed that the fluid collection had worsened, with it now extending into the posterior mediastinum from the postcricoid area of the hypopharynx to the aortic arch on the sagittal, axial, and coronal angles, respectively (Figures 2-6). The patient was taken to the operating room the following day in a joint effort by Otolaryngology and Thoracic Surgery. She underwent primary repair of cervical and thoracic esophageal perforation, sternocleidomastoid muscle flap reinforcement of the esophageal repair, and cervical and thoracic esophageal myotomy. Gastroenterology (GI) was also called into the operating room to assist with an esophagogastroduodenoscopy (EGD), which showed an esophageal tear 17 cm in length. The patient then had two esophageal stents placed in an overlapping fashion (Figures 7 and 8), as well as a nasogastric tube and G-tube. The patient had an esophagram 2 days later, with no contrast extravasation. However, the patient did aspirate She used her G tube for 3 weeks. Cultures of the abscess were taken, showing positivity for Prevotella bacteremia, and the patient was started on antibiotics. She then had another esophagram which showed no extravasation. She was allowed to eat orally and was able to do so well. She is doing well with no issues 5 months after surgery.