The patient had tachycardia, tachypnea and desaturation (SpO2=88%). Based on these symptoms and high D-Dimers, pulmonary embolism was suspected and CT pulmonary angiogram was requested which was negative for any pulmonary embolism; however, there was a suspicion of esophageal perforation which was later confirmed with repeat CT scan with positive oral contrast, due to unavailability of endoscopy services.

Upper GI endoscopy was performed after the 2nd CT scan which showed a large defect in the esophagus at 23-24 cm from the incisor. An esophageal stent was inserted endoscopically.

The left adrenal lesion was likely an incidentaloma, as it was stable since its initial detection on a CT abdomen done five years ago. Laboratory investigations done five years ago also did not show any endocrine abnormality.