Presentation
Chest pain.
Patient Data
There is a large mediastinal collection of air and contrast in the left side of the distal esophagus in the posterior mediastinum.
Several portions of the adjacent esophageal wall appear dehiscent and esophagus is diffusely thickened. This collection does not extend into the abdomen.
There is a moderate loculated left pleural effusion and a small right pleural effusion.
In the lungs, there is extensive ground-glass opacity and cystic change in both upper lobes as well as in the right middle lobe, suspicious for pneumonitis on a background of emphysema. There is a pericardial effusion and mediastinal lymphadenopathy.
Conclusion:
Posterior mediastinal esophageal perforation.
Case Discussion
Iatrogenic causes (e.g. endoscopy) of esophageal perforation are the most common.
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