Ligamentum arteriosum calcification mimicking esophageal perforation: A case report

The ligamentum arteriosum is a structure that connects the pulmonary artery to the aorta in the developing fetus. After birth it usually undergoes fibrous degenerative changes and calcification. Ligamentum arteriosum calcification (LAC) can be mistaken for an esophageal perforation, especially in patients with suspected esophageal foreign bodies or suspected esophageal injuries. A 16-month-old boy underwent elective surgery for congenital lipomyelomeningocele. The endotracheal intubation was technically difficult due to an anterior position of the larynx. Postoperatively he developed high fever and an elevated white blood cell count, which were concerning for an esophageal perforation. A computerized tomography (CT) scan with oral contrast with the patient in left latera decubitus due to recent lower back surgery was done and showed a hyperdense line near the aortopulmonary window, resembling an esophageal contrast leak. Knowing that LAC was in the differential, and before proceeding with any major interventions for a presumed esophageal injury we did a barium swallow study, which confirmed that there was no esophageal perforation. The patient recovered well. LAC is an uncommon condition that is difficult to distinguish from a contrast leak secondary to an esophageal perforation. A lack of awareness of condition can lead to unnecessary intervention.