Boerhaave syndrome
Updates to Article Attributes
Boerhaave syndrome refers to an oesophageal rupture secondary to forceful vomiting.
Epidemiology
It tends to be more prevalent in males. The estimated incidence is ~ 1:6000.
Clinical presentation
They are often associated with the clinical triad of vomiting, chest pain and subcutaneous emphysema (Mackler's triad). This condition was universally fatal before the age of surgery.
Pathology
It is thought occur due to a forceful ejection of gastric contents in an unrelaxed oesophagus against a closed glottis. The tears are vertically oriented, 1-4 cm in length. Approximately 90% occur along the left posterolateral wall (left diapgragmatic crus) of the distal oesophagus.
Radiographic features
Plain film
Chest radiograph
Imaging findings on plain film are often non-specific and may include pneumomediastinum or pleural effusion.
Other signs include:
- V sign of Naclerio - a focal, sharply marginated region of paraspinal radiolucency in on the left side immediately above the diaphragm 3
Fluoroscopy - contrast swallow
- up to 10% of patients have a false negative result 3
- may directly demonstrate contrast medium leakage, often at a supradiaphragmatic level
CT
Features reported on unenhanced CT scans include the presence intramural haematoma with a typical localisation and peri-oesophageal air collections indicating oesophageal perforation 2. Post contrast CT imaging may show direct contrast leakage/tracts and oesphageal wall thickening.
Other reported findings include
- presence of peri-aortic air tracts
- pneumothorax - has a left sided predilection
- pneumomediastinum
- mediastinal fluid collections
- oesphageal thickening 6
Treatment and prognosis
It can potentially cause a life threatening sepsis that can result in a high mortality (~35%) 1.
Etymology
It is named after Hermann Boerhaave, Professor of clinical medicine, Netherlands (1668-1738) 4. The syndrome was described after the case of Dutch admiral Baron Jan von Wassenaer, who died of the condition.
Related pathology
-<a href="/articles/naclerios-v-sign-2">V sign of Naclerio</a> - a focal, sharply marginated region of paraspinal radiolucency in on the left side immediately above the diaphragm <sup>3</sup>- +<a href="/articles/naclerio-v-sign-1">V sign of Naclerio</a> - a focal, sharply marginated region of paraspinal radiolucency in on the left side immediately above the diaphragm <sup>3</sup>
Image 6 CT (C+ portal venous phase) ( create )
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