pulmonary disorders
Mediastinitis
Esophageal perforation
 Esophageal Rupture may complicate esophagoscopy or insertion of a Sengstaken-Blakemore or Minnesota tube (for esophageal variceal bleeding). Rarely, it results from forceful vomiting (Boerhaave syndrome). Another possible cause is swallowing caustic substances (eg, lye, certain button batteries). Certain pills or esophageal ulcers (eg, in patients with AIDS and esophagitis) can contribute. Patients with esophageal perforation become acutely ill within hours, with severe chest pain and dyspnea due to mediastinal inflammation. is usually obvious from clinical presentation and a history of instrumentation or of another risk factor. The diagnosis should also be considered in patients who are very ill, have chest pain, and may have a risk factor that they cannot describe (eg, in patients who are intoxicated and may have vomited forcefully but do not remember and in preverbal children who may have ingested a button battery). The diagnosis is suggested by chest x-ray showing air in the mediastinum and confirmed by CT, although other disorders (eg, spontaneous Pneumomediastinum ) can also cause air in the mediastinum. 2 g IV once a day, for at least 2 weeks). Patients who have severe mediastinitis with Pleural Effusion or 