case_images: PMC8326610_01
case_images: (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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case_images: 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).
case_images: (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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case_images: 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).
case_images: Twelve-lead electrocardiogram showing sinus tachycardia, ST elevation in leads V1, V2, and V3, fulfilling left ventricular hypertrophy criteria.
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case_images: Electrocardiogram showed sinus tachycardia and ST-segment elevation in anterior leads, V1, V2, and V3 (Figure 3).
case_images: 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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case_images: 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.
case_images: 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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case_images: There were no features of tamponade seen (Figure 5).