Esophageal perforation

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Increasing mid-chest pleuritic pain since endoscopic esophageal dilatation ?perforation.

Patient Data

Age: 16 years
Gender: Female
ct

Small locule of gas is present outside the esophageal lumen, posterolateral to the caudate lobe of the liver. No other abnormal findings. 

Contrast swallow

Fluoroscopy

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%. 

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