In suspected esophageal perforation, which sign represents air leakage into the mediastinum?

In suspected esophageal perforation, which sign represents air leakage into the mediastinum?

• A. Hypoglycemia
• B. Peripheral edema
• C. Elevated bilirubin
• D. Crepitus on palpation of the neck or chest

Answer: (D)

Air escaping from a perforated esophagus into the mediastinum can track into the soft tissues of the neck and chest, producing subcutaneous emphysema. This manifests as crepitus felt on palpation—a crackling, air‑filled sensation under the skin. It’s a classic, physical-exam sign of mediastinal air and supports the diagnosis of esophageal perforation, which is a surgical emergency. The other options don’t reflect air leakage into the mediastinum. Hypoglycemia is a metabolic issue, peripheral edema suggests fluid overload or venous/cardiac problems, and elevated bilirubin points to liver or biliary disease. None of these indicate air in the mediastinum.

Air escaping from a perforated esophagus into the mediastinum can track into the soft tissues of the neck and chest, producing subcutaneous emphysema. This manifests as crepitus felt on palpation—a crackling, air‑filled sensation under the skin. It’s a classic, physical-exam sign of mediastinal air and supports the diagnosis of esophageal perforation, which is a surgical emergency.

The other options don’t reflect air leakage into the mediastinum. Hypoglycemia is a metabolic issue, peripheral edema suggests fluid overload or venous/cardiac problems, and elevated bilirubin points to liver or biliary disease. None of these indicate air in the mediastinum.