Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Esophageal perforation (BoerHaave syndrome)
- Radiologic Findings
- Figs 1. Chest PA shows large amount of left pleural effusion and pneumothorax
Fig 2-3. Chest CT scan shows circumferential wall thickening of esophagus and adjacent mediastinal fluid collection, and pneumomediastinum, and loculated pleural fluid collection with pleural thickening.
Fig 4-5. Chest CT shows focal esophageal wall defects just above the GE junction.
Figs 6. Gastrografin esophagography show contrast leakage on the just above the GE junction.
- Brief Review
- Esophageal rupture may be traumatic, neoplastic, or spontaneous. Boerhaave syndrome is a spontaneous esophageal rupture and very rare surgical emergency, most usually diagnosed in men aged 50-70 years. And it occurs in patients vomiting after ingestion of heavy meal combined with large alcohol consumption. Thy typical site of rupture is on the left posterior aspect of the distal esophagus, 2-3cm proximally to the gastroesophageal junction. The pathogenesis is sudden increased pressure caused by forceful vomiting against a closed glottis because of incomplete cricopharyngeal relaxation.
Clinical findings include vomiting, sudden severe chest pain, and subcutaneous emphysema. That is also called Macler`s triad. Dyspnea is frequently observed due to pneumothorax, pleural effusion, or atelectasis. However, in many cases the initial signs are nonspecific, such as sepsis, fever, and hypotension. It is misdiagnosed as acute aortic dissection, aortic rupture, myocardial infarction, perforated peptic ulcer, pancreatitis, or others.
Fluoroscopic esophagography with ingestion of water-soluble contrast medium was used to confirm suspected esophageal perforation throught the direct demonstration of extraluminal contrast extravasation. Currently, multidetector CT-esophagography has been useful diagnostic tool of Boerhaave syndrome.
- Please refer to
Case 658, Case 582, -
- References
- 1. Massimo Tonolini, Roberto Bianco. Spontaneous esophageal perforation (Boerhaave sybdrome) : Diagnosis with CT-esophagography. J Emerg Trauma Shock. 2013; 6(1):56-60
2. Nadir Ghanem, Carsten Altehoefer, Oliver Springer, Alex Furtwangler, Elmar Kotter, Oliver Schafer, Mathias Langer. Emergency radiology. 2003; 10(1):8-13
- Keywords
- Esophagus, Others,