Boerhaave's syndrome refers to nonpenetrating rupture of the esophagus. The usual site of rupture is in the left posterolateral portion of the distal thoracic esophagus.


Mechanism: rapid and sudden increase in intraesophageal pressure


Associated conditions:

(1) severe vomiting

(2) straining (Valsalva maneuver, heavy lifting)

(3) seizure

(4) blunt abdominal trauma


Clinical findings:

(1) sudden onset of excruciating substernal chest pain

(2) pain may radiate into the upper abdomen or to the interscapular space

(3) dyspnea and cyanosis are usually present

(4) fever is common

(5) subcutaneous emphysema may develop

(6) dysphagia


Changes on imaging studies:

(1) presence of free air in the mediastinum

(2) widening of the mediastinum

(3) development of a pleural effusion

(4) leakage of swallowed radiocontrast material


Delay in diagnosis and therapy increases the morbidity and mortality.


Differential diagnosis:

(1) dissecting aortic aneurysm

(2) perforation of a peptic ulcer

(3) acute pancreatitis

(4) pulmonary embolism

(5) spontaneous pneumothorax


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