Diagnostic Considerations

Important considerations

Even with a high index of suspicion, a negative water-soluble contrast study is not sufficient to rule out the diagnosis of esophageal tear.

Although evidence continues to accumulate regarding specific treatment approaches, this remains a rare condition and, as such, many suggestions are based on case series or personal experience.

Special concerns

Early diagnosis is crucial in Boerhaave syndrome. It is important to consider the possibility in any patient presenting with atypical chest or abdominal pain.

Differential Diagnoses

Workup

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Media Gallery

Nonenhanced CT scan through the mid esophagus in a patient with esophageal perforation after upper GI endoscopy shows a false tract emanating from the esophagus (arrow).
Nonenhanced CT scan through the mid esophagus in a patient with esophageal perforation after upper GI endoscopy shows leakage of oral contrast material (blue arrow) and air in the posterior mediastinum (red arrow).
Water-soluble contrast esophagram from a patient with esophageal perforation after esophageal dilation shows contrast leak (arrowheads) and normal esophageal lumen (arrows).

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Author

Ugo Anthony Ezenkwele, MD, MPH Vice Chief of Emergency Medicine, Woodhull Medical and Mental Health Center; Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, New York University School of Medicine

Ugo Anthony Ezenkwele, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, National Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Corey M Long, MD Resident Physician, Department of Emergency Medicine, Bellevue Hospital Center, New York University Medical Center

Corey M Long, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Martin J Carey, MD, MBBCh, MPH, FACEM, FRCS Program Director, Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences

Disclosure: Nothing to disclose.

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.