Boerhaave's Syndrome.

1Senior Registrar, 2Senior Specialist and Head, 3Registrar, Department of Medicine, Tata Main Hospital, Jamshedpur, Jharkhand Received: 07.11.2013; Revised: 28.01.2014; Accepted: 04.03.2014 A 58 year old male was admitted wi th complain of sudden onset severe central chest pain following a bout of vomiting after lunch. He was having a constricting feeling in the chest and upper abdomen associated with profuse sweating. There was no history of s imilar episode in the past nor he was having his tory of hypertension, diabetes mellitus, COPD or ischemic heart disease. He was a non-smoker, non-alcoholic with no history of any known drug allergy. On admission, the patient was dyspnoeic, looking distressed. Respiratory rate was 16/min, pulse 96/min, low volume, regular; blood pressure was 130/80 mm of Hg in the right upper limb in supine position. Auscultation of chest showed bilateral vesicular breath sound with few crepts i n l e f t i n f r a s c a p u l a r r e g i o n . Cardiovascular and nervous system examination did not reveal any abnormality. There was guarding on per abdominal examination. Pulse oximetry showed decreased oxygen saturation (SPO2 95%) on air. ECG on admission showed RBBB with left axis deviation. A provisional diagnosis of acute coronary syndrome with differential diagnosis of acute pancreatitis, acute cholecystitis, acute severe gastr i t is , oesophageal rupture (Boerhaave’s syndrome) was kept. Patient was kept on conservative m a n a g e m e n t . R o u t i n e b l o o d investigations were sent. Chest X-ray AP View (Figure 1) showed left-sided hydropneumothorax w i t h p n e u m o m e d i a s t i n u m . Ultrasonography showed moderate ant imicrobials and temporary venous pacing. Unfortunately, this patient had a rapidly downhill course and succumbed to her illness on the second day. Though ring abscess complicating prosthetic aortic valves are known, multiple abscesses in a native valve are exceedingly rare.1,2 As in this case, these may form an uncommon though sinister cause of complete heart block, and should be considered during evaluation of the same, especially in the young.