Boerhaave syndrome
Updates to Article Attributes
Boerhaave syndrome refers to an oesophageal rupture secondary to forceful vomiting.
Epidemiology
It tends to be more prevalent in males. The estimated incidence is ~ 1:6000.
Clinical presentation
They are often associated with the clinical triad of vomiting, chest pain and subcutaneous emphysema (Mackler's triad). This condition was universally fatal before the age of surgery.
Pathology
It is thought occur due to a forceful ejection of gastric contents in an unrelaxed oesophagus against a closed glottis. The tears are vertically oriented, 1-4 cm in length. Approximately 90% occur along the left posterolateral wall (left diapgragmaticdiaphragmatic crus) of the distal oesophagus.
Radiographic features
Plain filmradiograph
Chest radiograph findings are often non-specific and include pneumomediastinum and/or pleural effusion. Gas may also be seen with the soft tissue spaces of the chest wall and the neck. Other signs include
- V sign of Naclerio: a focal, sharply marginated region of paraspinal radiolucency in on the left side immediately above the diaphragm 3
Fluoroscopy
Fluoroscopy -On contrast swallow:
- up to 10% of patients have a false negative result 3
- may directly demonstrate contrast medium leakage, often at a supradiaphragmatic level
CT
Features reported on unenhanced CT scans include the presence intramural haematoma with a typical localisation and peri-oesophageal air collections indicating oesophageal perforation 2. Post contrast CT imaging may show direct contrast leakage/tracts and oesphagealoesophageal wall thickening.
Other reported findings include
- presence of peri-aortic air tracts
- pneumothorax: has a left sided predilection
- pneumomediastinum
- mediastinal fluid collections
- oesophageal thickening 6
- gas within soft tissue spaces of the chest wall and neck, and around the great vessels
- gas extending into spinal epidural, peritoneal and retroperitoneal spaces
Treatment and prognosis
It can potentially cause a life threatening sepsis that can result in a high mortality (~35%) 1.
History and etymology
It is named after Hermann Boerhaave,Professorprofessor of clinical medicine, Netherlands (1668-1738) 4. The syndrome was described after the case of Dutch admiral Baron Jan von Wassenaer, who died of the condition.
Related pathology
-<p><strong>Boerhaave syndrome</strong> refers to an <a href="/articles/oesophageal-perforation">oesophageal rupture</a> secondary to forceful vomiting.</p><p>Epidemiology</p><p>It tends to be more prevalent in males. The estimated incidence is ~ 1:6000.</p><p>Clinical presentation</p><p>They are often associated with the clinical triad of vomiting, chest pain and subcutaneous emphysema (Mackler's triad). This condition was universally fatal before the age of surgery.</p><p>Pathology</p><p>It is thought occur due to a forceful ejection of gastric contents in an unrelaxed oesophagus against a closed glottis. The tears are vertically oriented, 1-4 cm in length. Approximately 90% occur along the left posterolateral wall (left diapgragmatic crus) of the distal <a href="/articles/oesophagus">oesophagus</a>.</p><p>Radiographic features</p><p>Plain film</p><p><a href="/articles/chest-radiograph">Chest radiograph</a> findings are often non-specific and include <a href="/articles/pneumomediastinum">pneumomediastinum</a> and/or <a href="/articles/pleural-effusion">pleural effusion</a>. Gas may also be seen with the soft tissue spaces of the chest wall and the neck. Other signs include</p><ul><li>- +<p><strong>Boerhaave syndrome</strong> refers to an <a href="/articles/oesophageal-perforation">oesophageal rupture</a> secondary to forceful vomiting.</p><h4>Epidemiology</h4><p>It tends to be more prevalent in males. The estimated incidence is ~ 1:6000.</p><h4>Clinical presentation</h4><p>They are often associated with the clinical triad of vomiting, chest pain and subcutaneous emphysema (Mackler's triad). This condition was universally fatal before the age of surgery.</p><h4>Pathology</h4><p>It is thought occur due to a forceful ejection of gastric contents in an unrelaxed oesophagus against a closed glottis. The tears are vertically oriented, 1-4 cm in length. Approximately 90% occur along the left posterolateral wall (left diaphragmatic crus) of the distal <a href="/articles/oesophagus">oesophagus</a>.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p><a href="/articles/chest-radiograph">Chest radiograph</a> findings are often non-specific and include <a href="/articles/pneumomediastinum">pneumomediastinum</a> and/or <a href="/articles/pleural-effusion">pleural effusion</a>. Gas may also be seen with the soft tissue spaces of the chest wall and the neck. Other signs include</p><ul><li>
-</li></ul><p>Fluoroscopy - contrast swallow</p><ul>- +</li></ul><h5>Fluoroscopy</h5><p>On contrast swallow:</p><ul>
-</ul><p>CT</p><p>Features reported on unenhanced CT scans include the presence intramural haematoma with a typical localisation and peri-oesophageal air collections indicating oesophageal perforation <sup>2</sup>. Post contrast CT imaging may show direct contrast leakage/tracts and oesphageal wall thickening.</p><p>Other reported findings include</p><ul>- +</ul><h5>CT</h5><p>Features reported on unenhanced CT scans include the presence intramural haematoma with a typical localisation and peri-oesophageal air collections indicating oesophageal perforation <sup>2</sup>. Post contrast CT imaging may show direct contrast leakage/tracts and oesophageal wall thickening.</p><p>Other reported findings include</p><ul>
-</ul><p>Treatment and prognosis</p><p>It can potentially cause a life threatening sepsis that can result in a high mortality (~35%) <sup>1</sup>.</p><p>History and etymology</p><p>It is named after <strong>Hermann Boerhaave, </strong>Professor of clinical medicine, Netherlands (1668-1738)<sup> 4</sup>. The syndrome was described after the case of Dutch admiral Baron Jan von Wassenaer, who died of the condition. </p><p>Related pathology</p><ul>-<li><a href="/articles/mallory-weiss-tear-1">Mallory-Weiss tear</a></li>-<li><a href="/articles/oesophageal-rupture">oesophageal rupture</a></li>-</ul>- +</ul><h4>Treatment and prognosis</h4><p>It can potentially cause a life threatening sepsis that can result in a high mortality (~35%) <sup>1</sup>.</p><h4>History and etymology</h4><p>It is named after <strong>Hermann Boerhaave</strong>,<strong> </strong>professor of clinical medicine, Netherlands (1668-1738)<sup> 4</sup>. The syndrome was described after the case of Dutch admiral Baron Jan von Wassenaer, who died of the condition. </p>
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