Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Interval since prior study , the patient is a developed extremely extensive subcutaneous emphysema affecting the entire visual chest wall and extending into the supraclavicular region . In addition there is air tracking along the posterior mediastinum . The appearances are highly suspicious for an esophageal perforation . The extent of subcutaneous air limits assessment of the lungs , however no pneumothorax is visualized . An endotracheal tube is in - situ , the tip terminates approximately 2 .5 cm above the level the carina . Small left pleural effusion and left lower lobe atelectasis . The right lung is grossly clear .
    OUTPUT:
    
Extensive subcutaneous emphysema and a pneumomediastinum highly suspicious for an esophageal perforation .