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ABSTRACT Background Spontaneous pneumomediastinum (PM) is an uncommon radiographic finding that may indicate esophageal perforation and lead to further evaluation including transfer to a tertiary care center. We evaluated computed tomography (CT) findings and associated clinical features in patients with a suspected spontaneous esophageal perforation. Methods We retrospectively reviewed records of adults referred to a tertiary care center (January 2020–December 2024) for suspected spontaneous esophageal perforation with PM on CT. Patients with a history of recent surgery, endoscopy, or trauma were excluded. Clinical and imaging features between patients with and those without a confirmed perforation were compared by univariate analysis. Results Eighty‐two patients were included; 14 (17.1%) had a confirmed esophageal perforation and 68 (82.9%) did not. All perforations were noted in patients with pleural and/or mediastinal fluid (P/M fluid) and none were noted in patients without either. P/M fluid demonstrated a sensitivity of 100% and NPV of 100% for perforation ( p 0.05). Conclusions Patients with spontaneous PM on CT without pleural and/or mediastinal fluid are not at risk of esophageal perforation and can avoid further testing and transfer.
Keogan et al. (Thu,) studied this question.