Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia

Figure 1 Barium esophagogram before and after pneumatic dilations. A: Barium esophagogram before pneumatic dilations revealed a dilated distal esophageal lumen with bird-beak signs (arrow); B: Ingestion of gastrografin revealed no obvious immediate leakage of contrast medium immediately after pneumatic dilation (arrow).

Figure 2 Chest radiograph revealed left side pleural effusion, left lower lobe consolidation and air-fluid level over retrocardiac region air fluid level over the retrosternal area (arrow).

Figure 3 CT revealed esophageal dilatation and a rupture of the lower esophagus (arrow) with prominent pleural effusion (P) and fluid collection over the middle and lower mediastinum.