Presentation
Intoxicated patient presenting in shock following forceful vomiting.
Patient Data
Left pleural effusion with alveolar opacity of left lower lobe. Pneumomediastinum and gastric distension.
The study shows extensive peri-esophageal posterior mediastinal air collection, a ruptured distal esophagus is suggested. There is also a left pneumothorax, pneumomediastinum, bilateral pleural effusion prominent on the left side, and subcutaneous emphysema.
The barium swallow after surgery (thoracothomy with esophageal repair and muscular flap) reveals:
Normal swallowing and normal esophageal peristalsis.
No evidence of contrast leakage.
Case Discussion
Boerhaave syndrome is the perforation of the esophagus caused by forceful vomiting due to increased intra-esophageal pressure combined with relatively negative intra-thoracic pressure.
This syndrome is associated with Mackler's triad (vomiting, chest pain, and subcutaneous emphysema).
Chest x-ray and CT chest help to confirm the diagnosis of Boerhaave syndrome and should be considered immediately in suspected patients.
Special thanks to Professor Anuchit Ruamthanthong.
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