Presentation
Abdominal pain and vomiting, in florid psychosis. Background of schizophrenia and polysubstance abuse.
Patient Data
No acute intra-abdominal pathology. However there is a large tension pneumothorax with pneumomediastinum.
Posterior defect of the partially visualized distal esophagus, contiguous with the adjacent pneumomediastinum.
In view of these findings, a chest x-ray and CT chest were requested.
Large right sided tension pneumothorax with associated moderate pleural effusion and right lung collapse. Pneumomediastinum and subcutaneous emphysema also present.
Features of esophageal perforation in the distal third with diffuse thickening in keeping with esophagitis.
Decompression of the right tension pneumothorax with residual moderate volume right hydropneumothorax. Small left pleural effusion.
Overall findings are in keeping with Boerhaave's syndrome.
Case Discussion
A case of a large tension pneumothorax, likely secondary to Boerhaave's syndrome, masquerading as acute abdominal pain. This was in the likely setting of alcohol abuse. This highlights the importance of reviewing all check areas in a study.
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