Presentation
Retching followed by sudden onset sharp central chest pain.
Patient Data
Streaky linear lucencies noted along the left heart border, parallel to the superior mediastinum, and in the soft tissues of the neck, indicating pneumomediastinum. No pneumothorax. No airspace opacification.
The CT confirms the chest x-ray findings of pneumomediastinum, with gas within the central and superior mediastinum, and also within the soft tissues of the neck and chest wall.
There is no evidence of pneumothorax, pleural effusion or fluid in the mediastinum.
No leak of orally administered contrast from esophagus. Contrast is concentrated in the stomach.
No pneumoperitoneum.
Case Discussion
The history of retching followed by chest pain is typical of Boerhaave syndrome, so a CT with oral contrast was requested to check for leak of contrast from the esophagus, although it should be noted that this protocol has a limited sensitivity for the detection of leaks. The CT is helpful in confirming that there is no mediastinal "contamination" from leaked esophageal contents.
Case uploaded with the assistance of Dr Vikas Shah.
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