4. Chest CT
Upper endoscopy may ultimately be required for this patient if esophageal injury is suggested, but typically that diagnosis is first approached non-invasively. Cardiac MRI would be of value for assessment of cardiac function, possible pericardial disease, and even myocardial and aortic diseases, but the recently obtained historical information points more towards an esophageal etiology, and therefore cardiac MRI would not be the ideal test choice. Abdominal CT may show distal esophageal abnormalities and abnormalities involving the lung bases and inferior pleural space, but most thoracic causes for this patient’s presentation would only be partially visualized on abdominal CT and further imaging of the thorax would still be required. An esophagram is an appropriate test for this patient in light of the recently obtained historical information, but, when esophageal perforation is suspected, typically water-soluble oral contrast, not barium is employed, and therefore choice “3” is not the best choice.
Which of the following represents the optimal chest CT protocol for this patient? (Click on the correct answer to proceed to the eighth of nine pages)