The radiographer who had performed this portable case had noted the coiled nasogastric tube (NGT) upon acquiring the chest image. It was initially assumed on the chest image that the lucencies noted over the left side of the patient's neck was artefact from the patient's hair. An additional frontal neck image was then initiated to determine the extent of the coiled NGT in the upper gastrointestinal tract.

However, not only did the neck image show several coiled loops of the NGT, there was also significant left-sided subcutaneous emphysema. This raised the suspicion of an esophageal perforation, a rare yet serious medical emergency with a high mortality rate of 25 to 50% in some cases ^1-3.

On the subsequent CT scans, emphysema and mediastinitis as complications of the esophageal perforation were noted. The patient went on to have the perforated esophagus fixed intraoperatively.

In locations with only junior on-call doctors and minimal to no radiologists staffing after-hours, radiographers/radiologic technologists have to be vigilant in assessing their images for any critical medical emergencies when conducting portable x-ray examinations.