1457 Subcutaneous Emphysema in Adolescents: A Trap for The Unwary

Abstract A 16-year-old, Caucasian girl presented with sudden-onset pleuritic chest pain (CP), vomiting and shortness of breath. Nil past medical history; nil medications; trauma/ surgery. She was tachycardic, tachypnoeic apyrexial oxygen saturations >96% on air. There significant right-sided facial neck swelling. Chest palpation demonstrated crepitations suggesting subcutaneous emphysema (SE). Urinalysis negative. Laboratory tests revealed leucocytosis neutrophilia. X-Ray: SE. CT Thorax: extensive gas within mediastinal cavity tracking along great vessels tissues left, apical pneumothorax. Two air-filled tracts communicating between oesophagus cavity, ∼2cm from gastro-oesophageal junction, indicated oesophageal rupture. Conservative management included IV Fluids, antibiotics feeding via total parenteral nutrition. After 1-week, oral water-soluble-contrast administered. Subsequent imaging showed no evidence extra-luminal extravasation she discharged. At 4-week follow-up, normal dietary intake re-established complications. Discussion Boerhaave’s syndrome (BS) (described by Dutch physician Herman Boerhaave in 1724) is the phenomenon spontaneous perforation. The underlying mechanism due to a sudden rise intra-luminal pressure against closed glottis resulting barotrauma. BS adolescents remains rare entity paucity reported cases. Mackler’s triad describes classical presentation comprising vomiting, CP Non-specific may delay diagnosis high clinical index suspicion required. thorax studies are diagnostic. Timing presentation, complications haemodynamic status dictate conservative or surgical approach. carries 20-40% mortality, must be differential diagnoses presenting CP.