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Weekly Chest CasesArchive of Old Cases

Case No : 1053 Date 2018-01-01

  • Courtesy of Seungjin Kim, Kyungwon Doo, Jongwoon Song / Haeundae Paik Hospital, Inje University College of Medicine
  • Age/Sex 44 / F
  • Chief Complaintchest pain, dyspnea for 6 days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

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,

No. of Applicants : 105

▶ Correct Answer : 54/105,  51.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - staten island univ hosp , United States JOSEPH LOWRY
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - Chonnam National University Hwasun Hospital , Korea (South) INSOO JANG
  • - , Korea (South) JEYOUNG CHO
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Chonnam National University Hospital , Korea (South) GUNSU KIM
  • - Azienda Ospedaliera Universitaria Integrata di Verona , Italy GIAN ALBERTO SOARDI
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - HHS , Canada S LEE
  • - Seoul National University Hospital , Korea (South) JI EUN KIM
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Okayama Red Cross Hospital , Japan KAZUAKI MUNETOMO
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - University of Florence , Italy MARIAELENA OCCHIPINTI
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
  • - Louisiana State University - Shreveport , United States CARLOS H PREVIGLIANO
  • - , Korea (South) YOUNG EUN BAHN
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - , United States SIDHDHARTH DAMANI
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan TOMOKI WADA
  • - hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Samsung Medical Center , Korea (South) HYUN JUNG YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 6/105,  5.7%
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Dong-A University, College of Medicine , Korea (South) TAEHYUK HAM
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
▶ Semi-Correct Answer : 26/105,  24.8%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Apollo Hospitals , India SAMSON KADE
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) HAYEON LEE
  • - Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - Kyemyung University Dongsan Hospital , Korea (South) MINJAE GU
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - privato , Italy VINCENZO ENZO GENCHI
  • - Kyungpook national university hospital , Korea (South) Nari Jung
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Seoul National University Hospital , Korea (South) HYOUNG IN CHOI
  • - Radiologue , Cambodia HUY SOK
  • - Gwangju City hospital , Korea (South) HYUNGWOO OH
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Other , Korea (South) jin young kim
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Other , Korea (South) MINKYU KWAK
  • - Other , Korea (South) SEONGSU KANG
  • - Kyemyung University Dongsan Hospital , Korea (South) NAM YEOKYOUNG
  • - Escola Paulista de Medicina , Brazil RENATO MASSON DE ALMEIDA PRADO
  • - Residente , Chile SEBASTIAN ANDRES VILLARREAL
  • - pusan national university hospital , Korea (South) jiwon lee
  • - Kyemyung University Dongsan Hospital , Korea (South) DONG HYEON KIM
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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