The main symptom is pain at first, but the condition can progress to shock and even death if untreated.

For patients with perforation of the uppermost portion of the esophagus, neck pain or stiffness and air bubbles underneath the skin may be present.

For patients with perforation of the mid-portion or lower-most portion of the esophagus, difficulty swallowing, chest pain and difficulty breathing may be present.

Signs include fast breathing, rapid heart rate, low blood pressure and fever. A chest X-ray may demonstrate air in the soft tissues of the chest, fluid that has leaked from the esophagus into the space around the lungs, or collapse of the lung(s).

A chest CT scan may demonstrate formation of an abscess in the chest or evidence of esophageal cancer. A water-soluble contrast swallow (motion picture X-rays after drinking dye) may show the location of the perforation.