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Weekly Chest CasesArchive of Old Cases

Case No : 582 Date 2008-12-22

  • Courtesy of Jung Im Jung, MD. / St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
  • Age/Sex 39 / M
  • Chief ComplaintChest pain
  • Figure 1

Diagnosis With Brief Discussion

Diagnosis
Esophageal perforation (Boerhaave’s syndrome)
Radiologic Findings
Chest radiograph shows large amount of air-collections with fluid level in the lower mid mediastinum. Linear air-strands are noted from the mediastinum to the neck. Hydropneumothorax is noted in L lung and some pleural effusion is noted in the RLL.
Chest CT show large amount of air-collection around the esophagus and hydropneumothorax.
On operation, there was about 4cm sized, vertical rupture of left lateral wall of lower esophagus.
Patient had a history of vomiting after alcohol drinking before onset of symptom.
Brief Review
A sudden increase in intraluminal pressure of the esophagus causes a full thickness perforation of esophagus with mediastinitis. Most cases result from violent retching or vomiting after an alcoholic binge. Occasionally, however, spontaneous rupture of the esophagus may result from other causes of increased intra-esophageal pressure such as coughing, weightlifting, childbirth, defecation, seizures, status asthmaticus and blunt trauma to the chest or abdomen.

Esophageal perforations usually occur as 1 to 4cm, vertically oriented linear tears on the left posterolateral wall of the distal esophagus just above the esophagogastric junction. The distal esophagus is most vulnerable because of the lack of supporting mediastinal structures in this region and left side of esophagus is more vulnerable because right side of esophagus is protected by descending thoracic aorta.
The prognosis is related to the interval between the perforation and the initiation therapy.
References
White CS, Templeton PA, Attar S. Esophageal perforation. AJR 1993; 160; 767.
Keywords
Esophagus, Mediastinum, Trauma,

No. of Applicants : 90

▶ Correct Answer : 35/90,  38.9%
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - McGill University Health Centre , Canada Amr Ajlan
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - yashodha hospital , India pravin mahadevappa
  • - second hospital xian jiaotong university , China li ming
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - Mackay Memorial Hospital , Taiwan Shen-Yeh Shen
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
  • - KONARK DIAGNOSTIC CENTRE , India AHAMAD MUKARRAB
  • - Yashoda Super Speciality hospital , India Ramesh Pandey
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - CHRU lille , France manuel toledano
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - UZ Gent , Belgium Robert Gosselin
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - McGill University Health Center , Canada Alexandre Semionov
  • - DCA, , India Rajesh Gothi
  • - radiology department ANNECY , France gilles GENIN
  • - Mallinckrodt Institute of Radiology , United States Travis Henry
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - ASL BOLOGNA - MAGGIORE HOSPITAL- ITALY , Italy burzi marcellino
  • - AIIMS , India tariq matin
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - NMC hospital Dubai , United Arab Emirates vickrant malhotra
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Soonchunhyang university hospital, Bucheon , Korea (South) ALEUM LEE
  • - NASA SCANS , India RAKESH BHATIA
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Trakya University School of Medicine , Turkey Umut Ugur
▶ Correct Answer as Differential Diagnosis : 12/90,  13.3%
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - asl bologna - maggiore hospital- italy , Italy burzi marcellino
  • - National Taiwan University Hospital , Taiwan Chin-Chung Shu
  • - chest hospital , Egypt assaad assaad
  • - Radiologic clinic , Korea (South) sauree
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Saga University , Japan Ryoko Egashira
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - chp st martin , France Mariotte benoit
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
▶ Semi-Correct Answer : 32/90,  35.6%
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Asian Heart Institute, Nirman Hitech & Apollo clinic , India Jeshil R. Shah
  • - Osaka University , Japan Osamu Honda
  • - Ruby Hall Clinic , India Aniruddha Joshi
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - al watany hosp , Syria mohamad jader
  • - KMC,Manipal , India satish maddukuri
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - apollo hospitals , India harish bhambore
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - kims,narkatpally , India k bhaskar
  • - CHU Grenoble , France Fabrice Bing
  • - trakya iv. medical school department of radiology , Turkey ahmet POLAT
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - wonju christial hospital , Korea (South) Daekeon Lim
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - SKN MEDICAL COLLEGE, Pune , India Anubhav Khandelwal
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Hopital Edouard Herriot , France, Metropolitan Aymeric Guibal
  • - Gaziantep Kad Hastallarve Dom Hastanesi , Turkey Tay Bakar
  • - Gauhati medical College Hospital , India Hari Krishnan
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
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