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Image of the Month
Grace S. Rozycki, MD
From the Department of Surgery, Emory University, Atlanta, Ga.
Arch Surg. 2001;136:355-356.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. |
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INTRODUCTION
A 66-YEAR-OLD retired executive experienced sudden onset of severe interscapular pain after forceful vomiting. His medical history was notable for peptic ulcer disease and hiatal hernia, but he denied alcohol abuse. Remarkable findings on physical examination included decreased breath sounds and rales on the right side of his chest. Vital signs were blood pressure, 170/90 mm Hg; respiratory rate, 32 breaths per minute; heart rate, 116 beats per minute; and temperature, 36.8°C. Radiographs were obtained (Figure 1 and Figure 2).
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Figure 1.
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Figure 2.
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What Is the Diagnosis?
A. Malory-Weiss tear
B. Spontaneous rupture of the esophagus
C. Perforated duodenal ulcer
D. Severe gastritis
Answer: Esophageal Perforation (Boerhaave Syndrome)
Figure 1. Chest x-ray film showing right pleural effusion.
Figure 2. Esophagram demonstrating extravasation of contrast at right lower esophagus (arrows).
As a life-threatening problem, esophageal perforation should be diagnosed and treated rapidly to provide a good outcome for the patient and . . . [Full Text of this Article]
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