Oesophageal perforation

Case contributed by Dr Mahomed A. Osman

Presentation

Dermatomyositis with known oesophageal and gastric ulcers.

CT

Right sided pleural effusion with right basal atelectasis. Patchy consolidation is noted in the right and left lower lobes with surrounding tree-and-bud and centrilobular nodules most consistent with aspiration pneumonia. Air is noted in the posterior mediastinum adjacent to the oesophagus and extending along the left major fissure.

Fluoroscopy

Contrast swallow

Leakage of contrast from the right aspect of lower third of oesophagus with pooling in the right lower mediastinum.

Case Discussion

Pulmonary embolism could not be ruled out entirely in this case due to the poor contrast filling of the pulmonary trunk.

The differential for air in the mediastinum would include: ruptured oesophagus, alveolar rupture or bowel perforation.

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Case information

rID: 24166
Case created: 30th Jul 2013
Last edited: 10th Dec 2016
System: Chest
Inclusion in quiz mode: Included

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