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Esophageal perforation after trauma — ABEM Board MCQ

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HardTraumaEsophageal perforation after traumaABEM Board

A 55-year-old man arrives after forceful vomiting following blunt chest trauma. Triage acuity is ESI 2; BP 96/58 mm Hg, HR 128/min, T 101.2 F. He has severe chest pain, subcutaneous emphysema in the neck, and a left pleural effusion. ECG is nondiagnostic. Which of the following is the most likely diagnosis?

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Correct answer: D — Esophageal perforation

Severe chest pain after vomiting with sepsis, subcutaneous emphysema, and pleural effusion suggests esophageal perforation.

Reference: Emergency thoracic surgery guidance