Table 2.

Differential diagnosis table for intramural esophageal dissection.

	Radiographic findings	Contrast swallow	CT
Intramural esophageal dissection	Lateral neck radiograph may show thickened prevertebral soft tissue or a gas-distended esophagus. The classic double-barrel appearance may be appreciated.	Double-barrel esophagus or elongated tubular filling defect.	Presence of a mucosal flap with a submucosal distribution of gas (double-barrel appearance). The false lumen is usually larger and located posterior to the true lumen.
Mallory-Weiss tear	Usually normal.	Usually normal but mucosal irregularity may be demonstrated.	Usually normal.
Transmural esophageal perforation	Chest radiograph may show pneumomediastinum, a pleural effusion or hydropneumothorax (left > right).	Extravasation of contrast medium at the site of perforation. This is most commonly located on the left, just above the gastroesophageal junction.	Extra-luminal gas and peri-esophageal, pleural, and pericardial fluid collections.
Esophagitis	Usually normal.	Appearance can be varied, depending on the etiology. There may be mucosal nodularity, plaque-like defects, ulcers, and strictures.	Diffuse esophageal thickening, submucosal edema, and mucosal enhancement.