Presentation
Increasing mid-chest pleuritic pain since endoscopic esophageal dilatation ?perforation.
Patient Data
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Small locule of gas is present outside the esophageal lumen, posterolateral to the caudate lobe of the liver. No other abnormal findings.
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Mucosal irregularity of the anterior wall of the mid thoracic esophagus likely corresponds to the region of dilatation and represents a likely mucosal tear.
Acknowledgment: Dr David Wang.
Case Discussion
The evidence for esophageal perforation, a small locule of gas on CT and mucosal irregularity on fluoroscopic contrast swallow, is subtle but present in this case. Esophageal perforation is key to regonise because there is a mortality rate of ~20%.