36 year old Seema Rani gives a history of corrosive poisoning 3 months back. She has been suffering from severe dysphagia since then and it is more for solids than liquids. Endoscopic evaluation revealed a complex stricture involving the mid esophagus. Endoscopist tried dilatation of the stricture and post dilatation patient was complaining of severe chest pain and swelling of the neck. Resident doctor examined her and found surgical emphysema of the neck. She was kept nil per mouth and chest X-ray was taken. What would be the expected findings in that X-ray?
Iatrogenic perforation is the leading cause of esophageal perforations. Boerhaave's syndrome or spontaneous perforation of esophagus is induced by straining and vomiting. Any patient who presents with pain or fever following forceful vomiting, esophageal instrumentation, or chest trauma should be aggressively evaluated, with the aim of ruling out perforation of the esophagus. X-Ray findings are: Pneumomediastinum, subcutaneous emphysema, mediastinal widening, or a mediastinal air-fluid level. Pneumothorax may be present in up to 77% and 70% of the time it is on the left, 20% on the right and 10% bilaterally. Hydropneumothorax on the left is seen in patients with distal third esophageal perforations.
Left sided pleural effusion and Pneumomediastinum
Right sided pleural effusion with pneumomediastinum
Bilateral pleural effusion with left sided pneumothorax
Collapse of right lung and pericardial effusion