Usually patients have significant trauma with injuries to thoracic and/or abdominal organs.
Think of esophageal injury if:
(1) The track of a bullet, knife or other penetrating object passes through the esophagus.
(2) A penetrating wound to the neck that penetrates through the platysma muscle.
(3) Free air is present, either as clinical crepitus or radiographs showing free air in soft tissue or in the mediastinum.
(4) Pain in the chest, neck or abdomen.
(5) One or more of the following nonspecific symptoms: fever, coughing, choking, hematemesis, hemoptysis, hoarseness, dysphagia, or dyspnea.
(6) Mediastinal widening on chest X-rays
(7) Pleural effusion, hemothorax or pneumothorax.
(8) Unexplained hypotension or shock.
(9) Swelling in the neck.
Diagnostic modalities:
(1) X-rays taken while drinking water-soluble radiopaque contrast material may demonstrate extravasation of the fluid, but false negatives occur.
(2) endoscopy of the pharynx, esophagus and stomach
(3) thoracic CT scans
(4) examination during surgical exploration for other injuries
