Unusual cause of esophageal perforation during intraoperative transesophageal echocardiography monitoring for cardiac surgery--a case report

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.