Presentation
Shortness of breath.
Patient Data
A finding of pneumomediastinum with the air dissecting into the root of the neck, along the hilar structure, and the right minor fissure. No feature of tension pneumomediastinum, or pneumopericardium, no air dissecting below the diaphragm, and no subcutaneous emphysema. Clear mediastinal fat, no feature of mediastinitis.
A trans-mural esophageal perforation seen at the left lateral aspect measure 3x3.5mm located about 5cm superior to the esophageal hiatus, with no esophageal mass lesion or intramural hematoma.
Case Discussion
Esophageal perforation is a medical emergency that usually occurs in the distal one-third and most cases (unlike our case) are associated with pleural effusion. This patient was asthmatic and give a history of shortness of breath with few attacks of retching of one-day duration. His condition was worsening despite oxygen therapy, his initial chest X-ray (not available) was reported as normal and a CT scan was requested to explain his clinical deterioration.