Which of the following is the most likely diagnosis in a patient with chest pain radiating to the back, swallowing worsens symptoms, and subcutaneous crepitus after neck trauma?

• A. Esophageal Rupture
• B. Myocardial Infarction
• C. Pneumothorax
• D. Pericarditis

Answer: (A)

Painful tearing in the chest that gets worse when swallowing, along with subcutaneous crepitus after neck trauma, points to an esophageal rupture. When the esophagus tears, air and contents can leak into the mediastinum and soft tissues, creating mediastinal chest pain that often radiates to the back and a crackling sensation under the skin from subcutaneous emphysema. The neck trauma makes this injury more plausible because the cervical portion of the esophagus is vulnerable to blunt forces, and a full-thickness tear is a surgical emergency due to the risk of rapid infection and sepsis. The other conditions don’t typically produce both swallowing-provoked pain and subcutaneous crepitus in this context: a heart attack explains chest pain but not tearing pain with swallowing or emphysema; a pneumothorax can cause chest pain and crepitus but swallowing isn’t a defining feature; pericarditis presents with pleuritic chest pain and a different overall pattern and lacks crepitus. Emergent imaging and surgical management are critical if this diagnosis is suspected.