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Figure 1.
Chest X-Ray revealed
pneumomediastinum,
subcutaneous
emphysema, pleural
effusion and
pneumonia
DISCUSSION
• This patient with persistent chest pain,
vomitting and subcutaneous emphysema
(Mackler triad) should raise our suspicion
for esophageal perforation. Chest
radiograph showed features of
esophageal perforation with findings of
pneumomediastinum and subcutaneous
emphysema.
• However, these findings are not enough
to confirm the diagnosis of esophageal
perforation. Chest radiograph or MDCT
scan of chest and upper abdomen with
oral water-soluble contrast medium
should be performed to find a contrast
leak.
• In our case, both examinations could not
be done, because of the patient was
discharged against medical advice the day
after, and unfortunately our patient died 5
days post-discharge
CONCLUSION
• Chest radiograph showed features of
esophageal perforation with
pneumomediastinum and subcutaneous
emphysema found after ingesting
paraquat, but no esophageal contrast
study could be performed because the
patient was discharged against medical
advice.
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