Boerhaave Syndrome — RACP Adult Medicine MCQ

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ModerateEmergency MedicineBoerhaave SyndromeRACP Adult Medicine

A 45-year-old woman develops acute onset chest pain after vomiting. CXR shows left-sided pleural effusion and pneumomediastinum. She is tachycardic and febrile. What is the most likely diagnosis?

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Correct answer: D — Boerhaave syndrome (oesophageal perforation)

Boerhaave syndrome (spontaneous oesophageal perforation following forceful vomiting) presents with chest pain, subcutaneous emphysema, pneumomediastinum, and left-sided pleural effusion (Mackler triad). It is a surgical emergency with high mortality if diagnosis is delayed. CT with oral water-soluble contrast confirms the diagnosis. Management requires urgent surgical repair or endoscopic stenting plus broad-spectrum antibiotics and pleural drainage.

Reference: eTG – 2025 – Gastrointestinal; ANZACS – 2024 – Upper GI Emergencies