Correct!
5. The CT findings are diagnostic of esophageal rupture
The unenhanced phase of the chest CT examination shows pneumomediastinum clustering in proximity to the esophagus. On the second, oral contrast administration phase, the areas of pneumomediastinum clearly fill with oral contrast, indicating the presence of esophageal perforation (Figure 3).
Figure 3. A-F: CT esophagram following the intravenous injection of contrast material shows pneumomediastinum (arrowheads) clustering around the esophagus (decompressed soft tissue structure indicated by arrow). A small left pleural effusion (*) is present. No evidence of aortic pathology or pulmonary embolism is seen. G-L: CT esophagram following the oral administration of dilute intravenous contrast material shows the pneumomediastinum clustering around the esophagus detected on the first phase of the examination (A-F) fills with contrast on this phase of the examination (arrowheads), indicating esophageal rupture. Arrows= esophagus filled with orally administered contrast.
No evidence of pulmonary embolism or aortic dissection is present. The pericardium appears normal. Pleural effusion is present on the left, but the effusion is small, without pleural thickening, and the CT appearance does not suggest empyema.
The patient underwent surgical repair and recovered uneventfully.
Diagnosis: Esophageal rupture (Boerhaave's syndrome)
References