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Esophageal perforation

Case contributed by Mahomed A. Osman
Diagnosis certain

Presentation

Dermatomyositis with known esophageal 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 esophagus and extending along the left major fissure.

Contrast swallow

Fluoroscopy

Leakage of contrast from the right aspect of lower third of esophagus 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 esophagus, alveolar rupture or bowel perforation.

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