Korean J Helicobacter Up Gastrointest Res.  2012 Mar;12(1):38-41. 10.7704/kjhugr.2012.12.1.38.

Boerhaave Syndrome Presenting as Abrupt Onset of Massive Hydropneumothorax

• Kim T
• Kim HU
• Jang JW

• KMID: 2305178
• DOI: http://doi.org/10.7704/kjhugr.2012.12.1.38

Abstract

Boerhaave syndrome is a rare and life-threatening disease that often presents a diagnostic challenge. It is usually confused with critical but more prevalent diseases such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Boerhaave syndrome is caused by forceful vomiting resulting in a full-thickness tear of the middle or lower esophagus, typically an area of natural narrowing and at the esophagogastric junction and the left atrium. Because of these anatomic sites, hydropneumothorax, hemopneumothorax and pneumopericardium can occur. We report a case of a 48-year-old chronic alcoholic man presenting with abrupt onset of massive bilateral hydropneumothorax. In this case, it was hard to take a medical history from the patient due to sudden respiratory arrest when he arrived at the emergency room. Despite ongoing chest tube drainage, hydropneumothorax didn't improve. Pleural fluid amylase level was increased. Because of the possibility of esophageal rupture, esophagography was performed. As a result of the esophagography, he was diagnosed as Boerhaave syndrome with penumopericardium. If massive hydropneumothorax of unknown cause presents abruptly, boerhaave syndrome should be suspected as one of its causes. We recommend that pleural fluid amylase levels to be checked and if it is elevated, esophagography should be performed immediately.

Keyword

Boerhaave syndrome; Hydropneumothorax; Pneumopericardium; Amylases; Alcoholism

MeSH Terms

Alcoholics
Alcoholism
Amylases
Chest Tubes
Drainage
Emergencies
Esophageal Perforation
Esophagogastric Junction
Esophagus
Heart Atria
Hemopneumothorax
Humans
Hydropneumothorax
Mediastinal Diseases
Middle Aged
Myocardial Infarction
Pancreatitis
Peptic Ulcer
Pneumopericardium
Rupture
Vomiting
Amylases
Esophageal Perforation
Mediastinal Diseases