Doctor Chail, Good To Reach Back Out To You. As

Question: Doctor Chail,

Good to reach back out to you.

As you may recall, I have been complaining of very apparent gastrointestinal tears for months which have, until this point, gone completely undiagnosed, due to lack of clear radiological sign despite what I believe should be a high clinical suspicion chronically standing.

After months, the tears have gotten worse. For several weeks or more, it is now the esophagus that has sustained apparent tears.

SIGNS & SYMPTOMS

(1) One day, months ago, I was drinking a cold beverage, and all of a sudden, after swallowing, I feel most of it move straight down via the esophagus, as usual—but, for the first time, I noticed a second cold stream tracing out to the left, which traversed the distance between my gastric tube and the very left-most side of my ribs, near my armpit, just slightly below my collar bone.

Over time, the flow of fluids could be felt more clear, more pronounced, with increasing volumes of fluid moving across to the left--though I was not sure why it was moving to the left.

(2) One day, after drinking some diluted vodka (not smooth, very burning cheap quality), I felt the burn of the vodka POOLING UP at the left side by my ribcage in some intra-cavity pocket within the side of the chest behind the ribs, just behind the left-side ribs internally, under my armpit. The burning remained pooled up there distinctly until I drank more water to dilute it away.

(3) After recently doing a small amount of cocaine, the tear drastically worsened. (Cocaine is medically & clinically associated with gastric perforations and ischemias.)

(4) Following this, at a point now about two to three weeks ago, the accumulation of not only trace amounts of fluid were taking place, but most larger volumes of fluids and now masticated food could be felt moving in to the left.

(5) Whereas food and fluids would mostly be felt filling the stomach prior to this, now for the first time there is a NOTICEABLE lack of stomach-fill, and instead there is a filling of the left-side rib cage. This is evidenced by:

Feeling of cold fluids moving into the area,

(b) The expansion of the rib cage, which grows significantly larger on that side now for the first time in my life (including both the swelling of the area, and the relative tightening of skin and flsh around the growing ribcage, after each cup of beverage I would consume,

(c) A much heavy weightiness on my chest and upon my thoracic floor (diaphragm), which has never been felt before. This weightiness is so significant, that it noticeably and drastically shifts my center of gravity upwards,

(d) and also causes me to tip over the the left, as a result of the imbalance of weight on both sides.

(e) LOGICALLY: On chest X-rays or fluoroscopy, any fluid or matter that is diverted from the gastric tubes into the thoracic cavity, would necessarily flood around the area of the lungs, causing them to look smaller and essentially be constricted, while being similar in appearance to a collapsed lung. We know that a normal chest X-ray shows lungs clearly adhering to the entire frame and border, with clear, empty space all throughout.

However, issues of perforations to the esophagus tend to look similar to collapsed lung, in that the foreign fluid and matter volume now collecting in the thoracic cavity and around the lungs and organs there will cause a screening or blocking effect around the lungs, which may have a predictable type of appearance on a chest XRay.

I am asking for your prompt and urgent help in reading these radiographs, taken from an esophagram that was taken just a couple of hours ago. For our purposes, please:

(A) Familiarize, as necessary, with differences between normal chest X-ray, and chest X-ray of someone with confirmed esophageal perforation, with respect to the difference in lungs.


From study “Esophageal rupture: Computed tomography with endoscopic correlation”, the picture shown:

https://ars.els-cdn.com/content/image/1-s2.0-S0000-gr1.jpg


(B) Examine my own normal lung picture from an X-ray taken a few months ago (labeled ‘normal 2019’), and also the radiographic images taken from the fluoroscopy done today (labeled ‘2020_ESOxx’)—and compare to see if there are signs consistent with patient reports of feeling fluid and food volumes entering the chest cavity through an apparent esophageal tear.

(C) Collect info regarding other signs of esophageal perforation, and examine the radiographs carefully for any signs of them.

One study mentioning a list: “Such signs include pleural effusion, pneumomediastinum, subcutaneous emphysema, hydrothorax, pneumotho… pneumocardium and pneumoperitoneum are important diagnostic findings in these patients.”

(Also, other studies and pages mention other various specific signs of what to look for, for suspected cases of esophageal perforations. It is a bit of a long and complex list, I leave this part up to you, Doctor.)

IMPORTANT TO NOTE:

While this following radiograph is NOT mine, it is the nearly perfect representation of what I feel internally at its most clear signs.

http://www.jiaps.com/viewimage.asp?img=JIndianAssocPediatrSurg_2010_15_1_34_69142_f1.jpg

I could not figure out why the level of the feeling of fluid stayed up at that level. After observing this picture, I see it is because that is the top of the exterior of the lung organ, along which the fluid slides across, between the gastric tube, going all the way around over the top to the armpit. My reporting is exactly the same. There is no way I can make this up without having known that bit of anatomy, and just happen to be precisely correct and find an exact same representation of fluid flow from someone else who has it diagnosed correctly.

Images will be emailed to you promptly via the email service. Thank you so much Doctor.

-Jonathan