Presentation
Increasing mid-chest pleuritic pain since endoscopic esophageal dilatation ?perforation.
Patient Data
Small locule of gas is present outside the esophageal lumen, posterolateral to the caudate lobe of the liver. No other abnormal findings.
Mucosal irregularity of the anterior wall of the mid thoracic esophagus likely corresponds to the region of dilatation and represents a likely mucosal tear.
Acknowledgment: Dr David Wang.
Case Discussion
The evidence for esophageal perforation, a small locule of gas on CT and mucosal irregularity on fluoroscopic contrast swallow, is subtle but present in this case. Esophageal perforation is key to regonise because there is a mortality rate of ~20%.