{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:05:07Z","timestamp":1787321107423,"version":"build-2736575974"},"reference-count":14,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Spontaneous pneumomediastinum (PM) is an uncommon radiographic finding that may indicate esophageal perforation and lead to further evaluation including transfer to a tertiary care center. We evaluated computed tomography (CT) findings and associated clinical features in patients with a suspected spontaneous esophageal perforation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively reviewed records of adults referred to a tertiary care center (January 2020\u2013December 2024) for suspected spontaneous esophageal perforation with PM on CT. Patients with a history of recent surgery, endoscopy, or trauma were excluded. Clinical and imaging features between patients with and those without a confirmed perforation were compared by univariate analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eighty\u2010two patients were included; 14 (17.1%) had a confirmed esophageal perforation and 68 (82.9%) did not. All perforations were noted in patients with pleural and\/or mediastinal fluid (P\/M fluid) and none were noted in patients without either. P\/M fluid demonstrated a sensitivity of 100% and NPV of 100% for perforation (\n p<\/jats:italic>\n \u00a0<\u00a00.001). Patients with a perforation were significantly older (median 48 vs. 31\u00a0years;\n p<\/jats:italic>\n \u00a0=\u00a00.013), more commonly reported dysphagia (29% vs. 7.4%;\n p<\/jats:italic>\n \u00a0=\u00a00.042), had a higher white blood cell count (median 18.8 vs. 11.5\u00a0\u00d7\u00a010\n 3<\/jats:sup>\n \/\u03bcL;\n p<\/jats:italic>\n \u00a0=\u00a00.004), more often presented with respiratory compromise (43% vs. 5.9%;\n p<\/jats:italic>\n \u00a0=\u00a00.001), and had longer hospital stays (median 13.0 vs. 2.0\u00a0days;\n p<\/jats:italic>\n \u00a0<\u00a00.001) than those without; other symptoms (e.g., abdominal pain, vomiting, chest pain, and shortness of breath) and vital signs (laboratory values, including hemoglobin, CO\n 2<\/jats:sub>\n , and creatinine) were similar between groups (\n p<\/jats:italic>\n \u00a0>\u00a00.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Patients with spontaneous PM on CT without pleural and\/or mediastinal fluid are not at risk of esophageal perforation and can avoid further testing and transfer.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/wjs.70158","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T02:03:14Z","timestamp":1763690594000},"page":"3362-3367","source":"Crossref","is-referenced-by-count":5,"title":["Diagnostic Utility of Computed Tomography in Patients With Spontaneous Pneumomediastinum Evaluated for Suspected Esophageal Perforation"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-2454","authenticated-orcid":false,"given":"Andrew G.","family":"Keogan","sequence":"first","affiliation":[{"name":"Norton Thoracic Institute St. Joseph's Hospital and Medical Center Phoenix Arizona USA"},{"name":"Creighton University School of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Rybachok","sequence":"additional","affiliation":[{"name":"Creighton University School of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagar","family":"Patel","sequence":"additional","affiliation":[{"name":"Creighton University School of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3401-8623","authenticated-orcid":false,"given":"Andr\u00e9s R.","family":"Latorre\u2010Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Norton Thoracic Institute St. Joseph's Hospital and Medical Center Phoenix Arizona USA"},{"name":"Grupo de Investigaci\u00f3n Cl\u00ednica Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8681-968X","authenticated-orcid":false,"given":"Arianna","family":"Vittori","sequence":"additional","affiliation":[{"name":"Norton Thoracic Institute St. Joseph's Hospital and Medical Center Phoenix Arizona USA"},{"name":"Department of Surgery Oncology and Gastroenterology University of Padua School of Medicine Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2760-3891","authenticated-orcid":false,"given":"Sumeet K.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Norton Thoracic Institute St. Joseph's Hospital and Medical Center Phoenix Arizona USA"},{"name":"Creighton University School of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"StatPearls","author":"Kassem M. M.","year":"2023"},{"issue":"5","key":"e_1_2_12_3_1","article-title":"Aetiology, Treatment and Mortality After Oesophageal Perforation in Denmark","volume":"58","author":"Ryom P.","year":"2011","journal-title":"Danish Medical Bulletin"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.03.131"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.68396"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.5582\/irdr.2024.01020"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2009.06.058"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.04.067"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd\u201021\u2010193"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000029539"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2004.01.042"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0003\u20104975(03)00027\u20104"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.19.22166"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749\u20108090\u20103\u201059"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.21037\/med\u201023\u201025"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70158","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70158","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70158","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:05:01Z","timestamp":1787317501000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":14,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/wjs.70158"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70158","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]}}}