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Radiological Findings

Esophageal perforation can be diagnosed on frontal and lateral chest radiographs. Findings include pneumomediastinum, pneumothorax, hydro-pneumothorax, subcutaneous emphysema and pleural effusions (Fig. 2.30). Chest radiography is not useful

Fig. 2.29a-c. Balloon dilation of an esophageal stricture. a Severe stenosis of the proximal esophagus 3 months after repair. b Dilatation balloon expanded across the narrowing, no extravasation. c Post-dilatation appearance

Fig. 2.30a,b. Esophageal perforation after orogastric tube malposition. a Frontal chest radiograph with left pleural effusion, left pulmonary atelectasis and mediastinal shift. Free air overlies the cardiac silhouette. b Lateral chest radiograph confirms the traumatic pneumothorax

with cervical esophageal perforation. Airway films are required if there is concern for cervical esophageal perforation. Contrast swallow is falsely negative in 10% (Gimenez et al. 2002). CT is recommended when the esophagram is negative and there is high suspicion of perforation.

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