Age: 55
Sex: Male
Indication: Vomiting, chest pain
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Case #18
Findings
Chest radiograph
- Pneumomediastinum with gas tracking into the neck
- Moderate left and small right pleural effusions
- Patchy bibasilar opacities
CT
- Chest
- Large volume pneumomediastinum with extensive infiltration of the paraesophageal fat
- Small left pneumothorax
- Large left and moderate right pleural fluid collections
- Dependent consolidation and groundglass opacities throughout the left greater than right lungs
- 8 mm right upper lobe pulmonary nodule
- Scattered cystic changes throughout both lungs with bilateral lower lobe bronchiectasis
- Moderate coronary artery calcification
- Abdomen/Pelvis
- Borderline dilation of multiple loops of small bowel
- Hepatic steatosis
- MSK
- No acute findings
- Circumscribed lucent lesions in the right iliac bone
Diagnosis
- Esophageal perforation (Boerhaave syndrome)
Sample Report
Large volume pneumomediastinum with paraesophageal fat stranding concerning for esophageal perforation (Boerhaave syndrome) in this patient with reported history of emesis. Recommend esophagram for further evaluation.
Small left pneumothorax.
Large left and moderate right pleural fluid collections with overlying airspace disease which is particularly concerning for aspiration in the setting of emesis.
8 mm right upper lobe pulmonary nodule. Recommend followup CT imaging in 3 months for further assessment.
Findings concerning for underlying cystic lung disease and/or sequela of chronic aspiration, which can be reassessed at time of followup imaging.
Indeterminate lucent lesions in the right iliac bone which are likely benign in the absence of a history of cancer. These can also be reassessed on followup imaging.
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