Arterial phase with oral contrast (misprotocoled - should have been without IV contrast).
Once again the extensive pneumomediastinum is noted. Bilateral pleural effusions andconsolidation is noted.
There is hold-up of oral contrast within the oesophagus. There is however oral contrast noted in the stomach and pylorus but noted reaching the duodenum. There is a small amount of contrast noted extending into the left pleural cavity. A discrete point of leak is not identified. Again the large hiatus hernia is noted and on this with migration of the fundoplication into the thorax.
Once again the upper abdominal contents are unremarkable.
Boerhaave syndrome with contrast extravasation into the left hemithorax. A discrete rupture point however is not identified.