Snapshot quiz 18/8
Authors: Steele CW and Robertson K
This 40-year-old labourer presented with a 2-day history of central chest pain radiating to his back following strenuous vomiting after significan alcohol consumption. Clinical examination revealed dullness to percussion at the left lung base, and subcutaneous emphysema across the thorax consistent with Boerhaave syndrome (ruptured oesophagus). He was tachycardic and hypoxic. CT demonstrated mediastinal emphysema and a large left pleural effusion. Thoracotomy confirmed a linear perforation bridging the gastro-oesophageal junction (see figure). The defect was closed primarily. Lavage and large-bore drainage of the mediastinal cavity and thorax was performed.