What clinical sign is appreciated that is indicative of an esophageal perforation
The correct answer and explanation is:
Correct Answer: Subcutaneous emphysema
Explanation:
A key clinical sign that indicates esophageal perforation is subcutaneous emphysema, which is the presence of air in the subcutaneous tissues. It is often felt as a crackling or popping sensation under the skin when palpated, especially in the neck, upper chest, or face.
Esophageal perforation is a life-threatening condition that occurs when there is a hole or rupture in the esophagus. It may result from trauma, endoscopic procedures, severe vomiting (as in Boerhaave syndrome), ingestion of foreign bodies, or corrosive substances. The location of the perforation influences the clinical presentation, but some signs are consistently noted.
Subcutaneous emphysema occurs because air escapes from the esophagus into the surrounding mediastinum and then tracks into subcutaneous tissues. When air enters the mediastinum, it can also lead to mediastinal emphysema (pneumomediastinum), and this may progress to cause Hamman’s sign, which is a crunching sound heard over the precordium synchronized with the heartbeat.
Other symptoms of esophageal perforation include:
- Severe chest pain or neck pain
- Dysphagia (difficulty swallowing)
- Odynophagia (painful swallowing)
- Fever and signs of infection due to leakage of esophageal contents into the mediastinum
- Tachycardia and hypotension, which can indicate sepsis
However, subcutaneous emphysema remains one of the earliest and most recognizable physical signs. A chest X-ray or CT scan may confirm the presence of air in the soft tissues and mediastinum, supporting the diagnosis. Early detection and surgical or medical intervention are critical to prevent complications such as mediastinitis, sepsis, and death.
Prompt recognition of subcutaneous emphysema in a patient with chest pain and risk factors for esophageal perforation is essential for timely diagnosis and treatment.