Esophageal Perforation

  • Etiology: placement of a nasogastric tube, forceful vomiting or retching (Boerhaave syndrome), blunt trauma
  • CXR: pneumomediastinum, pneumopericardium, pneumothorax
  • Note: a nasogastric tube that is too straight after placement and that does not gently curve into the stomach should be suspected of not being in the stomach
  • UGI: contrast outside of esophagus
  • Complications: mediastinitis
  • Treatment: often conservative
  • Clinical: can be devastating if not recognized

Cases of Esophageal Perforation

CXR of esophageal perforation from nasogastric tube placement
CXR AP shows air outlining the heart in the pericardial space, air outlining the thymus in the mediastinum, and air in the bilateral pleural spaces.
AXR of esophageal perforation from nasogastric tube placement
Supine AXR (above) shows increased lucency in the upper abdomen. The cross-table lateral AXR (below) shows air between the anterior abdominal wall and the bowel. The nasogastric tube follows a very straight course and does not curve towards the stomach. Note on both views that the tip of the nasogastric tube does not project over the stomach. US performed subsequently showed the tip of the nasogastric tube was in the retroperitoneum and not in the stomach.