Predictive criteria for oesophageal perforation in patients with pneumomediastinum: can invasive diagnostic modalities be avoided?

Clinical features such as dysphagia and vomiting, together with specific CT signs (mediastinal fluid, pleural effusion and oesophageal wall disruption), strongly predict OP in patients with PNM. Patients who are asymptomatic and lack these high-risk features are unlikely to have an OP and can probably be managed conservatively without invasive testing. These findings may help clinicians risk-stratify patients with PNM and avoid unnecessary admissions and invasive procedures.