RAD6 Esophageal perforation: A pictorial review of a sinister condition. (Radiology).

RAD6 ESOPHAGEAL PERFORATION: A PICTORIAL REVIEW OF A SINISTER CONDITION. Alejandro Mendez-Castillo, MD, Keneth Rall, MD, and Jennifer Turner, MD. University of Missouri, Columbia.

Perforation of the esophagus, either iatrogenic or spontaneous is an uncommon but life-threatening condition that requires immediate treatment. Spontaneous perforation of the esophagus (Boerhaave's syndrome) accounts for approximately 15% of all cases of esophageal perforation and remains a difficult entity to diagnose early. The classic triad of vomiting, chest pain and subcutaneous emphysema is seldom present. Delayed treatment of this condition is associated with a high mortality. Prompt diagnosis and treatment are critical for survival of the patient. Mortality as high as 20% if not treated within the first 24 hours of perforation, 50% if treatment is postponed beyond 24 hours, and of 100% if the perforation is diagnosed after 7 days of its occurrence have been reported. Therefore it is of crucial importance that the radiologist and the treating physician are familiar with both the clinical and the radiological presentations of this condition. We describe four cases of esophageal perforation, two of which were spontaneous. We discus the clinical presentation of esophageal perforation and have compiled a number of radiological images that includes all different modalities used at this time to accurately diagnose this sinister entity.