Boerhaave Syndrome

Published on 06/08/2015 by admin

Filed under Radiology

Last modified 06/08/2015

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 Usually from left side of distal thoracic esophagus

• Chest film

image Left side pleural effusion or hydropneumothorax
image Radiolucent streaks of gas along aorta or in neck
• Esophagography with nonionic, water-soluble contrast agent

image Shows extravasation of ingested or injected (through nasogastric tube) contrast medium
image From left side of esophagus, just above gastroesophageal (GE) junction
image If initial study with water-soluble contrast medium fails to show leak, examination must be repeated immediately with barium to detect subtle leaks
• CT

image Extraluminal gas &/or oral contrast medium in lower mediastinum &/or upper abdomen


• Mallory-Weiss syndrome
• Pulsion diverticulum (epiphrenic)
• Iatrogenic (postinstrumentation) injury


• Accounts for 15% of total esophageal perforation cases
• Prognosis for large perforation

image After 24 hours without treatment: Mortality = 70%
image After immediate surgical drainage: Good
• Treatment

image Drains in esophagus, mediastinum, pleural space, &/or abdomen
(Left) Graphic shows a vertically oriented laceration image of the distal esophagus, just above the hiatus and gastroesophageal (GE) junction.

(Right) Film from an esophagram following injection of a water-soluble contrast medium through a nasogastric tube demonstrates a leak of contrast medium image from a tear in the left anterior wall of the distal esophagus image, a classic appearance for Boerhaave syndrome.
(Left) Axial CECT in a middle-aged man with severe chest pain after repeated retching shows extraluminal gas and contrast material image surrounding the esophagus in the lower mediastinum and upper abdomen.

(Right) Film from a fluoroscopic exam in the same patient during injection of water-soluble contrast through a nasogastric tube shows extraluminal contrast in the mediastinum and upper abdomen image. The site of the tear is the left anterior wall image of the distal esophagus.



• Spontaneous distal esophageal perforation following vomiting or other violent straining


General Features

• Best diagnostic clue

image Extraluminal gas and contrast material in lower mediastinum surrounding esophagus
• Other general features

image Sudden increase in intraluminal pressure leads to full-thickness esophageal perforation
image Left side of distal thoracic esophagus

– Most vulnerable (due to lack of supporting mediastinal structures)
– Vertical, full-thickness tear, 1-4 cm long

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