In the neck trauma scenario with chest pain and crackling on palpation, which finding would support esophageal rupture?

• A. Jaundice
• B. Subcutaneous emphysema
• C. Hypotension
• D. Nuchal rigidity

Answer: (B)

Subcutaneous emphysema is the finding that supports esophageal rupture. When the esophagus tears, air escapes into the mediastinum and can track into soft tissues of the neck and chest, producing a crackling, palpable sensation under the skin known as subcutaneous emphysema. This physical finding directly reflects air in the tissues, which is a hallmark of an esophageal perforation after trauma.

Jaundice wouldn’t be expected from an esophageal tear and points to liver or biliary problems. Hypotension can occur with severe injury or sepsis but isn’t specific to esophageal rupture. Nuchal rigidity suggests meningitis or cervical spine issues, not rupture of the esophagus.