Penetrating aerodigestive injuries and the role of computed tomography esophagography

Penetrating neck injuries can be fatal if not quickly identified; however, operative intervention is not always necessary. Prompt evaluation with imaging studies aids in identifying patients who need intervention. A retrospective, single-center study of patients with PNI from 2017 to 2022 was performed. Management, outcomes, and mortality were compared. Sensitivity and specificity were calculated for imaging studies performed. Of 436 patients with PNI, 72 had an aerodigestive injury: 42(58 ​%) underwent operative management, and 30(42 ​%) underwent nonoperative management. There was no difference in mortality. The sensitivity and specificity of computed tomography (CT) esophagography for hypopharyngeal/esophageal injury were 100 ​%. The sensitivity and specificity of fluoroscopic esophagography were 71 ​% and 99 ​%. The sensitivity and specificity of combined fluoroscopic esophagography and flexible esophagoscopy were 100 ​%. In select patients with penetrating aerodigestive injuries, nonoperative management is safe. CT esophagography alone may be sufficient to identify a hypopharyngeal/esophageal injury. •Penetrating neck injuries can result in significant morbidity and mortality.•Diagnostic imaging is essential to determine appropriate management for PNIs.•In select patients with aerodigestive injuries, non-operative management is safe.•CT esophagography may be sufficient to identify hypophyngeal/esophageal injury.