Findings

-The CXR shows aberrant air secondary to the perforated esophagus; subcutaneous emphysema and pneumomediastinum.

-There is widening of the mediastinum and a left pleural effusion.

-The BaSw demonstrates extensive extravasation of contrast material through the lower esophageal perforation.

Discussion

Boerhaave’s Syndrome, or “spontaneous” esophageal perforation, usually presents with a linear tear through the lower esophageal wall secondary to vomiting against a closed glottis. The patients are frequently inebriated. Aberrant air is the usual radiologic presentation; pneumomediastinum occurs first. The air then tracks into the neck, producing deep cervical emphysema, which may rupture, producing subcutaneous emphysema. The pneumomediastinum may rupture into the pleural space causing a life threatening pneumothorax. Mediastinitis is the usual clinical presentation. Reported mortality estimate is approximately 35%, making it the most lethal perforation of the GI tract.

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