Soft-tissue case 40. Presentation
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* Lorenzo Ferri
* David Mulder

An 81-year-old man presented to the Emergency Department with progressive shortness of breath 6 hours after an episode of forceful vomiting. The patient was normotensive and afebrile but tachycardic. Chest examination revealed decreased breath sounds in the left hemithorax. A plain chest radiograph was obtained (Fig. 1), and a left thoracostomy tube was placed, which drained 2 litres of dark fluid. A subsequent contrast esophagogram was obtained (Fig. 2).

![FIG. 1](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/44/4/259/F1.medium.gif)

[FIG. 1](http://canjsurg.ca/content/44/4/259/F1)

FIG. 1 

![FIG. 2](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/44/4/259/F2.medium.gif)

[FIG. 2](http://canjsurg.ca/content/44/4/259/F2)

FIG. 2 

Can you make the diagnosis?

For the answer and discussion see page 306.

## Footnotes

*   Section Editor: Lawrence A. Stein, MD

*   Submissions to Radiology for the Surgeon, soft-tissue section, should be sent to Dr. Lawrence A. Stein, Department of Radiology, Royal Victoria Hospital, 687 Pine Ave. W, Montreal QC H3A 1A1.