A lesson in clinical findings, diagnosis, reassessment and outcome: Boerhaave's syndrome

Abstract

A man in his 30s presented with a brief episode of vomiting, acute abdominal pain and subsequent development of shortness of breath. On initial examination and investigation, the clinical impression was of a right-sided pneumothorax, pneumonia and pleural effusion. Early antibiotic treatment and management showed a clinical improvement, with the patient reporting resolution of his symptoms. This episode was short lived, with a further deterioration in his condition and worsening of symptoms. Ensuing examination, imaging and investigations demonstrated an oesophageal leak into the right pleural cavity. Following urgent stabilisation measures and insertion of a chest drain, he underwent successful surgical repair. Boerhaave's syndrome is an emergency situation, requiring quick recognition, diagnosis, aggressive treatment and management to optimise a good outcome.

Figure 1

Admission chest film showing right-sided effusion, small pneumothorax and lower zone consolidation.

Figure 2

Demonstrating an obvious leak from the distal oesophagus into the right pleural cavity with contrast.