Discussion and Conclusions
CT performed before initial incision and drainage of retropharyngeal abscess showed confinement to the retropharyngeal space (Figure 1). Following increased pain at the surgical site, repeat imaging showed extension into the mediastinum from the sagittal, axial, and coronal angles, respectively (Figures 2-6). Esophagram was performed and showed no extravasation, although the patient did aspirate (Figure 7). Based off of the patient history, we postulate that the esophageal perforation that occurred was a result of an increase in pressure due to patient activity. According to the patient, she had been yelling at her significant other for quite some time, with no other voice-related activity. With no episodes of vomiting or ingestion of a foreign body recorded prior to the esophageal rupture, combined with a chest x-ray showing no pneumoperitoneum, Boerrhave’s syndrome was ruled out (Figure 8). Our case we believe is the first study showing a spontaneous esophageal perforation following an incision and drainage of a retropharyngeal abscess.