Multiplanar imaging immediately following oral contrast. There is extensive pneumomediastinum and subcutaneous emphysema, more so on the right.
Several thin low density bands are seen within the lung parenchyma of the right upper lobe. These extend to the periphery in the right lung apex medially and are in keeping with mild pulmonary interstitial emphysema.
There is no evidence of pulmonary haemorrhage, alveolar consolidation or atelectasis.At the anterior right lung apex, there is an apparent small discontinuity of the pleura with a tiny 1mm wide channel of air seen between lung parenchyma and upper mediastinal gas; this may represent the site of air leak. There is no pneumothorax and no pleural effusion. No bullous or cystic lung disease. No mediastinal fluid or collection is seen.
Conclusion: Extensive pneumomediastinum and subcutaneous emphysema likely due to alveolar rupture or pulmonary interstitial emphysema, both these entities can be related to barotrauma. The leak is suspected in right apex. There are no features to suggest a ruptured oesophagus.