Boerhaave's syndrome - tension hydropneumothorax and rapidly developing hydropneumothorax: two radiographic clues in one case

Abstract

Boerhaave's syndrome is a rare and severe condition with high mortality partly because of its atypical presentation resulting in delayed diagnosis and management. Diagnostic clues play an important role in the approach to this syndrome. Here, we report a 48 year-old male patient hospitalized with fever and left chest pain radiating into the interscapular area. Two chest radiographs undertaken 22 h apart showed a rapidly developing tension hydropneumothorax. The amylase level in the pleural fluid was high. The fluid in the chest tube turned bluish after the patient drank methylene blue. The diagnosis of Boerhaave's syndrome was suspected based on the aforementioned clinical clues and confirmed at the operation. The patient recovered completely with the use of antibiotics and surgical treatment. In this case, we describe key findings on chest radiographs that are useful in diagnosing Boerhaave's syndrome.

Keywords: Boerhaave's syndrome; hydropneumothorax; methylene blue; pleural effusion; tension pneumothorax.

Figure 1

Two consecutive chest radiographs with tension hydropneumothorax. A) Chest radiograph on admission in the tertiary hospital with left hydropneumothorax, the visceral pleura edge is discernible (white arrows). B) A supine chest radiograph taken 22 h later shows left hemithorax white‐out and increasing tracheal deviation to the right (black arrow).

Figure 2

The drainage system shows the fluid in the chest tube presenting a bluish discolouration (white arrow).