Boerhaave syndrome refers to an oesophageal rupture secondary to forceful vomiting. Originally described in 1724 by Hermann Boerhaave, a Dutch physician/botanist. The syndrome was described after the case of a Dutch admiral Baron Jan von Wassenaer who died of the condition.
It tends to be more prevalent in males. The estimated incidence is at ~ 1:6000 patients.
They are often associated with the clinical triad of vomiting, chest pain and subcutaneous emphysema (also called Mackler's triad). This condition was universally fatal before the age of surgery.
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's in length. Approximately 90% occur along the left posterolateral wall (left diapgragmatic crus) of the distal oesophagus.
Plain film - chest radiograph
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 - contrast swallow
Upto 10% of patients may have a false negative result 3. May directly demonstrate contrast medium leakage often at a supra-diaphragmatic level.
Features reported on unenhanced CT scans include the presence intramural haematoma with a typical localisation and periesophageal air collections indicating esophageal perforation 2. Post contrast CT imaging may show direct contrast leakage / tracts and oesphageal wall thickening.
Other reported findings includes
- presence of peri-aortic air tracts
- pneumothorax - has a left sided predilection
- mediastinal fluid collections
- oesphageal thickening 6
It can potentially cause a life tretening septic insult which can result in a high mortality ( ~ 35%) 1
Named after Hermann Boerhaave : Professor of clinical medicine, Netherlands (1668 - 1738) 4
- 1. Neff C, Lawson DW. Boerhaave syndrome: interventional radiologic management. AJR Am J Roentgenol. 1985;145 (4): 819-20. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Ghanem N, Altehoefer C, Springer O et-al. Radiological findings in Boerhaave's syndrome. Emerg Radiol. 2003;10 (1): 8-13. doi:10.1007/s10140-002-0264-1 - Pubmed citation
- 3. Giménez A, Franquet T, Erasmus JJ et-al. Thoracic complications of esophageal disorders. Radiographics. 2002;22 Spec No : S247-58. Radiographics (full text) - Pubmed citation
- 4. Kanne JP, Rohrmann CA, Lichtenstein JE. Eponyms in radiology of the digestive tract: historical perspectives and imaging appearances. Part I. Pharynx, esophagus, stomach, and intestine. Radiographics. 26 (1): 129-42. doi:10.1148/rg.261055084 - Pubmed citation
- 5. Lee S, Mergo PJ, Ros PR. The leaking esophagus: CT patterns of esophageal rupture, perforation, and fistulization. Crit Rev Diagn Imaging. 1997;37 (6): 461-90. Pubmed citation
- 6. White CS, Templeton PA, Attar S. Esophageal perforation: CT findings. AJR Am J Roentgenol. 1993;160 (4): 767-70. AJR Am J Roentgenol (citation) - Pubmed citation
- 7. Backer CL, Locicero J, Hartz RS et-al. Computed tomography in patients with esophageal perforation. Chest. 1990;98 (5): 1078-80. Chest (citation) - Pubmed citation
- 8.^ H. Boerhaave. Atrocis, nec descripti prius, morbis historia: Secundum medicae artis leges conscripta. Lugduni Batavorum; Ex officine Boutesteniana. 1724
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Oesophageal rupture secondary to forceful vomiting||✗|
|Esophageal rupture secondary to forceful vomiting||✗|