PMC8326610_01
(A) Supine, portable, anteroposterior radiograph of the chest shows left tension pneumothorax (blue arrow). (B) Axial contrast-enhanced computed tomography at the level of the heart shows thickening of the esophagus with air foci anteriorly (black arrowhead).
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The chest radiograph on admission showed a left-sided tension pneumothorax (Figure 1A). Computed tomography (CT) scan of the thorax showed mediastinal air and distal esophageal thickening suggestive of esophageal perforation (Figure 1B).
(A) Axial contrast computed tomography through the level of the heart demonstrates loculated pneumothorax (white arrow) and left para mediastinal fluid collection (*). (B) Upright, dynamic esophagogram showed contrast pooling above the diaphragm (+) and a contained contrast leak (blue arrowhead) in the lower esophagus posteriorly.
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Repeat CT thorax showed a thick-walled left paramediastinal collection with air and fluid levels, new from the prior study (Figure 2A). Repeat esophagogram showed a contained esophageal perforation (Figure 2B).
Twelve-lead electrocardiogram showing sinus tachycardia, ST elevation in leads V1, V2, and V3, fulfilling left ventricular hypertrophy criteria.
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Electrocardiogram showed sinus tachycardia and ST-segment elevation in anterior leads, V1, V2, and V3 (Figure 3).
Bedside transthoracic echocardiogram parasternal short-axis view showing a moderate pericardial effusion with multiple echo dense debris (white arrow), new from prior study.
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Bedside echocardiogram showed a moderate pericardial effusion with echo dense floating debris (Figure 4), which was new compared with a recent study obtained 3 days earlier.
Axial contrast computed tomography through the level of the heart demonstrates pneumopericardium (blue arrows), with loss of fat plane between the posterior pericardium and esophagus (white arrow). Additionally, a large pericardial effusion (*) is seen, with bilateral pleural effusions and a loculated left pneumothorax.
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There were no features of tamponade seen (Figure 5).