Curriculum for Specialty Certificate Examination in Gastroenterology

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Monday, 21 April 2014

what is your diagnosis?

A 62 years oled male presented with severe chest pain and hypotension after vomiting.


Ct shows bilateral pleural effusion and pneumomediastinum to the aorta and to the right of the oesophagus. Subsequent CT with oral contrast shows dense contrast in the oesophagus (arrow) and leakage into the irregular complex right mediastinal collection.

The diagnosis is Boerhaave syndrome.

Spontaneous rupture of the oesophagus during vomiting.
May follow alcohol ingestion or lage meal.
Rupture typically located at the left subdiaphragmatic portion of the oesophagus.
Classical presentation: Mackler traid:
-Vomiting
-Severe chest pain
-Subcutaneous emphysema

1 comment:

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