Abstract
A 21-year-old woman was admitted with respiratory failure, fever, hypotension, and tachycardia. She had had nausea and vomiting over the previous fortnight. On pulmonary auscultation she had coarse bilateral breath sounds and bibasilar dullness. Computed tomography of the chest showed anterior mediastinal air and large bilateral pleural empyemas (figure). Chest tubes were placed for empyema drainage and broad-spectrum antibiotics were started. Endoscopy showed a 1·5 cm esophageal tear. Thoracotomy with mediastinal drainage was done.
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