A 45-year-old man presents with severe retrosternal chest pain, tachycardia, and subcutaneous emphysema of the neck following an episode of forceful vomiting. Which imaging study is most appropriate for initial diagnostic evaluation?

• A Plain chest X-ray
• B Water-soluble (Gastrografin) esophagogram ✓
• C Barium swallow
• D CT chest without oral contrast

Explanation

Water-soluble contrast esophagogram is the initial study of choice for suspected esophageal perforation (Boerhaave syndrome). If negative and suspicion remains high, barium swallow follows as it has higher sensitivity for small leaks. Gastrografin is preferred first because barium extravasation into the mediastinum causes inflammatory mediastinitis. CT chest is supportive but not definitive alone.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.