PURPOSE: To determine which CT findings are useful for the early diagnosis of esophageal perforation, and on the basis of these findings, to assess the accuracy of prediction of the perforation site. MATERIALS AND METHODS: A review of medical records indicated that between January 1995 and December 2001, 36 patients with esophageal perforation were admitted to our hospital. Thirteen of these [M:F=8:5; age: 28-69 (mean, 52.4) years], who had undergone CT chest scanning, were included in this study. The causes of esophageal perforation were trauma (n=5), infectious diseases (n=4), Boerhaave syndrome (n=1), lung cancer (n=1), esophageal cancer (n=1), and idiopathic (n=1). Two chest radiologists unaware of the clincal findings reviewed the CT scans and predicted whether the upper or lower esophagus was perforated. RESULTS: The most common CT finding was extraluminal air at the posterior mediastinum (n=11), while other findings included pulmonary consolidation (n=10), pleural effusion (n=7), discontinuity of the esophageal wall (n=6) and subcutaneous emphysema (n=4), fluid collection around the esophagus (n=4), esophageal wall thickening (n=4), pneumothorax (n=2), and lung abscess (n=2). The perforation site was accurately predicted in 76.9% of cases (10/13). CONCLUSION: The CT findings which help the diagnosis of esophageal perforation, and prediction of the sites at which it occurs, are extraluminal air or fluid collection, focal defect of the esophageal wall, and esophageal wall thickening.