Demystifying the persistent pneumothorax: role of imaging

Insights into Imaging

Table 1 Protocol for obtaining CT in patients with a suspected oesophageal respiratory fistula

	Z axis coverage	IV Contrast	Oral contrast*
Initial noncontrast	Thoracic inlet – below diaphragm	None	None
Second phase with IV and oral contrast	Thoracic inlet – below diaphragm	50–75 cc at 2–3 cc/s, images acquired at 40 sec delay	75–300 mL of an aqueous solution consisting of IV iodinated contrast material Omnipaque 350
Prone/Decubitus (if needed)	Limited over region of suspicious perforation	None	50 mL of an aqueous solution consisting of IV iodinated contrast material Omnipaque 350

^* At least 1 mL of Omnipaque 350 per 37.4 cc of water [60]. A more concentrated 10 % solution is better to delineate these defects [19]. If patient is able to swallow, they are instructed to hold their breath and swallow; otherwise, they are asked to sip continuously from a cup with a straw. In unconscious patients, contrast may be injected thorough a nasogastric (NG) tube