Answer: C. Gastrografin (water-soluble) contrast esophagography.
We recommend an initial attempt with a water-soluble agent in patients who are awake and alert and are not at risk for aspiration.
Barium sulfate is superior for identifying small perforations; however, it may incite an inflammatory response in tissue and should only be used if no initial perforation is identified with water-soluble contrast.
Endoscopy is generally not recommended except in cases of penetrating trauma because insufflation could potentially enlarge a minimal transmural opening.
Interesting Medical Case, read here: Pneumopericardium from Perforated Esophageal Ulcer