The leaking esophagus: CT patterns of esophageal rupture, perforation, and fistulization

Esophageal perforation can be a catastrophic event for a patient regardless of the etiology of the perforation. Contrast esophagrams can typically diagnose an esophageal perforation if the clinical symptoms or history suggest the diagnosis. Often, however, the clinical features are atypical and a CT scan is performed early in the patient's workup. It is, therefore, essential to recognize the CT features seen in esophageal perforation. The various etiologies and CT findings of esophageal perforation are reviewed in this article. The CT abnormalities include extraluminal air, periesophageal fluid, esophageal thickening, and extraluminal contrast. These CT findings may be the first clue to the correct diagnosis of esophageal perforation.