The radiology of perforated oesophagus

Abstract

The nature of the plain film changes resulting from perforation of the oesophagus depend upon the site of perforation, the integrity or otherwise of the mediastinal parietal pleura, and the time interval between perforation and radiological investigation. Initial radiographs taken within minutes of perforation may be normal, and soft tissue emphysema, mediastinal widening and abscess formation may not be detected for up to 24 hours. Cervical oesophageal perforation produces cervical emphysema early, but mediastinal abnormalities are rare if the condition is treated promptly. Intrathoracic perforation promotes early mediastinal changes such as emphysema and abscess formation. If the mediastinal pleura is ruptured there is early development of hydro- or pyopneumothorax. If pleural integrity is maintained, mediastinal changes develop rapidly and a pleural effusion appears late. The site of oesophageal perforation and any interconnecting mediastinal and pleural spaces are reliably demonstrated by a water-soluble contrast medium swallow with radiographs taken with a horizontal beam , with the patient prone, supine, right and left decubitus.