Abstract
Spontaneous pneumomediastinum (PM) is an uncommon radiographic finding that may indicate esophageal perforation and lead to further evaluation including transfer to a tertiary care center. We evaluated computed tomography (CT) findings and associated clinical features in patients with a suspected spontaneous esophageal perforation.
We retrospectively reviewed records of adults referred to a tertiary care center (January 2020-December 2024) for suspected spontaneous esophageal perforation with PM on CT. Patients with a history of recent surgery, endoscopy, or trauma were excluded. Clinical and imaging features between patients with and those without a confirmed perforation were compared by univariate analysis.
Eighty-two patients were included; 14 (17.1%) had a confirmed esophageal perforation and 68 (82.9%) did not. All perforations were noted in patients with pleural and/or mediastinal fluid (P/M fluid) and none were noted in patients without either. P/M fluid demonstrated a sensitivity of 100% and NPV of 100% for perforation (p < 0.001). Patients with a perforation were significantly older (median 48 vs. 31 years; p = 0.013), more commonly reported dysphagia (29% vs. 7.4%; p = 0.042), had a higher white blood cell count (median 18.8 vs. 11.5 × 10
/μL; p = 0.004), more often presented with respiratory compromise (43% vs. 5.9%; p = 0.001), and had longer hospital stays (median 13.0 vs. 2.0 days; p < 0.001) than those without; other symptoms (e.g., abdominal pain, vomiting, chest pain, and shortness of breath) and vital signs (laboratory values, including hemoglobin, CO
, and creatinine) were similar between groups (p > 0.05).
Patients with spontaneous PM on CT without pleural and/or mediastinal fluid are not at risk of esophageal perforation and can avoid further testing and transfer.