About 15% of oesophageal perforations spontaneously arise from vigorous vomiting (Boerhaave syndrome). Such cases present with chest pain an...
About 15% of oesophageal perforations spontaneously arise from vigorous vomiting (Boerhaave syndrome). Such cases present with chest pain and dysphagia. A partial-thickness tear (Mallory-Weiss syndrome) is associated with blood-tinged vomiting and chest pain. Iatrogenic injury is the most common cause of oesophageal perforation.
PLAIN FILM/CT
• Pneumomediastinum and subcutaneous emphysema.
• Pleural effusion or hydropneumothorax.
• Left lower lobe atelectasis.
• Widening of the mediastinum may accompany the development of mediastinitis or mediastinal haematoma.
WATER-SOLUBLE SWALLOW
• The leak is most often just above the diaphragm at the left posterolateral edge.
Boerhaave syndrome. Frontal chest radiograph demonstrating large volume pneumomediastinum and subcutaneous emphysema with a left pleural effusion.
Boerhaave syndrome. Axial CT image of the chest with intravenous contrast demonstrating a perforation of the oesophagus (white arrow) with pneumomediastinum and bilateral pleural effusions.
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