Boerhaave’s Syndrome

摘要: I mages n E mergency M edicine Boerhaave’s Syndrome J. Shaun Smith DO Jennnifer W. McCallister MD Ohio State University Medical Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Columbus, OH Supervising Section Editor: Sean Henderson, Submission history: Submitted July 21, 2009; Revision Received September 2, Accepted 14, 2009 Reprints available through open access at http://escholarship.org/uc/uciem_westjem [West J Emerg Med. 2010; 11(1):74-75.] Figure 2. Computed tomography the chest with pneumo- hydrothorax mediastinal air, where black arrowhead indicates hydrothorax, white arrow pneumothorax, air. 1. Radiograph left-sided pneumo-hydrothorax, pneumothorax. A 66-year-old Caucasian male no past medical history presented to emergency department (ED) complaining severe retrosternal pain, which began immediately prior arrival following an episode vomiting. The patient had symptoms including nausea, vomiting generalized abdominal discomfort for three days prior. been evaluated by a primary care physician earlier day presentation was diagnosed gastroenteritis possible early small bowel obstruction per computed (CT) scan abdomen pelvis. released home anti-emetics. On ED in moderate distress secondary pain hemodynamically stable. Physical exam remarkable absent breath sounds over left hemithorax. Chest Western Journal Emergency Medicine radiography revealed pneumo-hydrothorax (Figure 1). Subsequent CT also demonstrated as well air 2). Laboratory studies showed normal comprehensive metabolic panel coagulation profile; however, CK-MB elevated 6.70 ng/ml (3.60-5.00), leukocytosis 11.9 TH/ul (4.0-9.0). Electrocardiograph sinus rhythm ventricular rate 87. 28 French tube inserted, draining 600 mL dark blood-tinged fluid. Based on radiographic findings clinical presentation, esophageal rupture diagnosis. transferred tertiary center confirmed barium esophagram. Surgical repair successfully performed. Patients classically present subcutaneous emphysema. Pain may radiate neck, arm or back is aggravated deep breathing swallowing. myriad other be present, hoarseness, Volume XI, . 1 : February 2010