Esophageal Perforation

History: 50 year old male with a recent surgical intervention in the cervical esophagus. 

Esophageal perforation: Single image in left posterior oblique projection from an esophagram shows contrast leaking from the esophagus into the soft tissues of the anterior neck. Note the NG tube in the esophagus. Also note the contrast exiting the neck via a surgical drain in place (arrow).

This patient was status post resection of his Zenker diverticulum a few days prior to the esophagram. When esophageal perforation is the clinical question, it is essential that the first portion of the esophagram be completed with water soluble contrast such as omnipaque in order to prevent chemical mediastinitis or pleuritis and pneumonitis.