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Boerhaave syndrome — RCPSC EM MCQ

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HardGI/Abdominal emergenciesBoerhaave syndromeRCPSC EM

A 47-year-old woman has sudden severe chest pain after repeated vomiting. She is febrile, tachycardic and has subcutaneous emphysema in the neck. Chest radiograph shows a left pleural effusion and mediastinal air. What is the most appropriate investigation?

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Correct answer: D — CT chest with water-soluble oral contrast and urgent thoracic surgery consultation

Boerhaave syndrome causes oesophageal rupture after forceful vomiting, with chest pain, sepsis, mediastinal air and pleural effusion. CT with water-soluble contrast and urgent surgical involvement are required.

Reference: Canadian thoracic surgery principles; Rosen's Emergency Medicine