Boerhaave’s Syndrome
نویسندگان
چکیده
Figure 1. Radiograph of left-sided pneumo-hydrothorax, where the black arrowhead indicates the hydrothorax and the white arrow indicates the pneumothorax. A 66-year-old Caucasian male with no past medical history presented to the emergency department (ED) complaining of severe retrosternal pain, which began immediately prior to arrival following an episode of vomiting. The patient had symptoms including nausea, vomiting and generalized abdominal discomfort for three days prior. The patient had been evaluated by a primary care physician earlier the day of presentation and was diagnosed with gastroenteritis and possible early small bowel obstruction per computed tomography (CT) scan of the abdomen and pelvis. The patient was released home with anti-emetics. On presentation to the ED the patient was in moderate distress secondary to pain and hemodynamically stable. Physical exam was remarkable for absent breath sounds over the left hemithorax. Chest radiography revealed a left-sided pneumo-hydrothorax (Figure 1). Subsequent CT of the chest also demonstrated pneumo-hydrothorax, as well as mediastinal air (Figure 2). Laboratory studies showed normal comprehensive metabolic panel and coagulation profile; however, the CK-MB was elevated at 6.70 ng/ml (3.60-5.00), and a leukocytosis of 11.9 TH/ul (4.0-9.0). Electrocardiograph showed normal sinus rhythm with a ventricular rate of 87. A 28 French chest tube was inserted, draining 600 mL of dark blood-tinged fluid. Based on radiographic findings and clinical presentation, esophageal rupture was the primary diagnosis. The patient was transferred to a tertiary center where Boerhaave's was confirmed with a barium esophagram. Surgical repair was successfully performed. Patients classically present with chest pain, vomiting and subcutaneous emphysema. Pain may radiate to the neck, arm or back and is aggravated by deep breathing or swallowing. A myriad of other findings may be present, including hoarseness, Figure 2. Computed tomography of the chest with pneumo-hydrothorax and mediastinal air, where the black arrowhead indicates the hydrothorax, the white arrow indicates the pneumothorax, and the black arrow indicates the mediastinal air.
منابع مشابه
Boerhaave’s Syndrome Unusual Presentation in a 4 Month Old Infant, a Case Report and Review of Literature
Boerhaave’s syndrome is associated with spontaneous rupture of lower end of esophagus after a bout of vomiting, leading to chest pain and sub cutaneous emphysema, pneumomediastinum and leakage of fluids in to the base of the lungs. Boerhaave’s syndrome is rare in paediatric practice. Only 28 cases were reported in children till date. The youngest child reported to have boerhaave’s syndrome was ...
متن کاملSpontaneous Rupture of the Oesophagus: Boerhaaves Syndrome in 2008
Objective: Boerhaave’s syndrome is a spontaneous rupture of the oesophagus with a lack of diagnostic and treatment consistency in the literature. Therefore, we reviewed all published literature in order to design a treatment algorithm based on the literature. Study Design: A systematic literature review written in the English language since 1975. Results: We reviewed all known literature. Treat...
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Spontaneous Esophagus Perforation: A Rare Case
Boerhaave’s syndrome (spontaneous esophageal rupture) is a rare entity, which is characterized by a rare and late diagnosis. It is a life-threatening condition and requires early diagnosis and urgent care. The most common etiological factor is emesis. A history of forceful emesis, subxiphoid chest pain, and subcutaneous emphysema is a common triad of symptoms that should suggest spontaneous rup...
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A 61-year-old alcoholic man presented to the emergency department because of vomiting and dyspnea after discharged from hospital due to appendectomy two days ago. He smoked heavily and his past medical history revealed gastritis. On the examination, he was hypotension (50/00 mmHg) and lethargy. Cardiopulmonary resuscitation was initiated aggressively. His chest x-ray showed right-sided tension ...
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Transmural perforation of the esophagus following an effortful vomiting is a rare but fatal condition. This situation, known as Boerhaave’s syndrome, is caused by spontaneously occurring perforations. The esophagus is not resistant to reflexes such as nausea and vomiting because it lacks serosal layers. Boerhaave syndrome, in which substantial amounts of spontaneous perforations occur, is gener...
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