Boerhaave syndrome

Case contributed by Dr Craig Hacking


Sudden chest pain post coughing and vomiting.

Patient Data

Age: 32
Gender: Male
Modality: X-ray

There is a veiling opacity over the left hemithorax, likely from pleural fluid on the supine film. There is a retrocardiac opacity that obscures the diaphragmatic silhouette, indicating left lower lobe consolidation.

Modality: CT

The main pulmonary trunk is not dilated. There is no pulmonary embolus.

There are bilateral pleural effusions noted and pneumomediastinum with gas noted around the distal oesophagus and stomach. There is an associated hiatus hernia demonstrated. There are probably small gas locules noted within the distal oesophageal and stomach wall. Gastric volvulus cannot be excluded.

The remainder of the visualised abdominal contents within the limitation of the studyare unremarkable.


  • Pneumomediastinum and bilateral pleural effusions and consolidation with an appearance suggestive of Boerhaave syndrome. Gastric volvulus cannot be absolutely excluded.
  • Correlation with a water soluble contrast swallow may be indicated to further.

CT with oral contrast

Modality: CT

Arterial phase with oral contrast (misprotocoled - should have been without IV contrast).

Once again the extensive pneumomediastinum is noted. Bilateral pleural effusions andconsolidation is noted.

There is hold-up of oral contrast within the oesophagus. There is however oral contrast noted in the stomach and pylorus but noted reaching the duodenum. There is a small amount of contrast noted extending into the left pleural cavity. A discrete point of leak is not identified. Again the large hiatus hernia is noted and on this with migration of the fundoplication into the thorax.

Once again the upper abdominal contents are unremarkable.


Boerhaave syndrome with contrast extravasation into the left hemithorax. A discrete rupture point however is not identified.

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Case Information

rID: 39382
Case created: 2nd Sep 2015
Last edited: 5th May 2016
Inclusion in quiz mode: Included

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