The radiology of perforated oesophagus

Spontaneous pneumomediastinum in children

“…The serious morbidity associated with esophageal perforation 65 means that this possibility must be eliminated by contrast radiography, preferably in the lateral decubitus position. 63 The choice of contrast medium is controversial. 62,65,69,70 One option is to use ®rst a watersoluble product, followed, if the ®ndings are normal, by a barium meal to improve sensitivity.…”

Spontaneous closure of esophageal tear in Boerhaave's syndrome

“…Classically, the patient with esophageal rupture presents the triad of vomiting, followed by excruciating low thoracic pain, and subcutaneous emphysema [9]. Other symptoms include dyspnea and extreme thirst.…”

Trauma to the esophagus

“…The roentgenographic investigation of suspected perforation of the esophagus may be accomplished in two stages: plain film findings and contrast examinations [5].…”

“…The 'V' sign of Naclerio, a triangular lucency seen through the heart which has been associated with lower esophageal perforation, has been variously ascribed to emphysema in the triangular ligament, as well as to chemical mediastinitis [5,10]. In addition, pneumoperitoneum may be seen.…”

“…Gastric contents may also be seen in the pleural space. Radiographs are exposed in the supine cross-table+ left and right lateral decubitus positions [5]. At this level the esophageal musculature becomes thinner to merge with the stomach, and on the left side the esophagus is closely applied to the left parietal pleura; the esophagus has crossed anterior to the descending aorta and has become a left-sided organ, effectively removed from the right mediastinal pleura [3, 121. Contrast esophagograms help to confirm the diagnosis of perforation of the esophagus, but the condition is not excluded by a negative study [13].…”