Boerhaave syndrome

Case contributed by Dr Craig Hacking

Presentation

Sudden chest pain post coughing and vomiting.

Patient Data

Age: 35 years
Gender: Male
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.

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.

Conclusion

  • Pneumomediastinum and bilateral pleural effusions and consolidation with an appearance suggestive of Boerhaave syndrome. Gastric volvulus cannot be absolutely excluded.
  • Correlation with repeat CT with swallowed water soluble contrast advised.
CT

CT with oral contrast

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

Once again the extensive pneumomediastinum is noted. Bilateral pleural effusions and consolidation is noted.

There is hold-up of oral contrast within the oesophagus. There is a large amount of contrast in the posterior mediastinum surrounding and a small amount of contrast noted extending into the left pleural cavity. A discrete point of leak is suspected posteriorly just superior to the hiatus hernia.

The upper abdominal contents are unremarkable.

Conclusion

Boerhaave syndrome with contrast extravasation into the posterior mediastinum and left hemithorax.

Case Discussion

Case confirmed at surgery.

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Case information

rID: 39382
Case created: 2nd Sep 2015
Last edited: 9th Nov 2017
Inclusion in quiz mode: Included

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