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To the Editor:—
Dr. Popper has made an important point regarding the laboratory diagnosis of esophageal rupture. Analysis for hydrochloric acid of the aspirated pleural fluid accompanying rupture would be of great help in confirming the diagnosis. This emphasizes how crucial it is for the clinician to keep the possibility of spontaneous rupture of the esophagus in mind in patients with severe chest or abdominal pain. If his clinical suspicion can be corroborated by laboratory studies, including the one suggested by Dr. Popper, the early diagnosis of this catastrophe will be aided and proper surgical therapy instituted.
Kelley ML. Test for Esophageal Rupture. JAMA. 1965;192(2):174. doi:10.1001/jama.1965.03080150103040