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
