Emanciated, loss of weight, right apex opacity on chest x-ray? TB? occult malignancy?
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Extensive pneumomediastinum and fluid in the mediastinum. Proximal oesophagus is air-filled and distended to the level of T7 and after this it is largely collapsed. Moderate sized bilateral pleural effusions and a small right apical pneumothorax. Severe centrilobular emphysema.
Boerhaave syndrome is spontaneous oesophageal rupture from forceful vomiting. After initialy concerns for the pneumomediastinum secondary to perforation oesophageal malignancy, this case was given the clinical diagnosis of Boerhaave syndrome.