Boerhaave's syndrome presenting as a right-sided pleural effusion.

INTRODUCTION Boerhaave's syndrome is an uncommon condition where there is oesophageal rupture following forceful vomiting, subsequent mediastinitis and is associated with high mortality and morbidity in the absence of therapy. We present a case of Boerhaave's syndrome in a 79-year-old woman who developed a right-sided effusion, an unusual presentation. CLINICAL PICTURE A 79-year-old woman developed a right-sided empyema and mediastinitis after a bout of repeated vomiting. Gastrograffin swallows and oesophago-gastroduodenoscopy confirmed oesophageal rupture. TREATMENT The patient was treated with antibiotics and a tube thoracostomy. An open thoracotomy, oesophagostomy and thoracic window was subsequently performed. OUTCOME The oesophageal rupture was contained but patient died from postoperative complications. CONCLUSIONS Physicians should have a high index of suspicion of oesophageal rupture when patients present with Meckler's triad of symptoms and especially when pleural fluid cultures grow bacteria native to the gastrointestinal tract.