- 作者：Manabu Suzuki ; MD&lowast ; ; &dagger ; ; ; Naoki Sato ; MD&lowast ; ; Junya Matsuda ; MD&lowast ; ; Naoya Niwa ; MD&lowast ; ; Koji Murai ; MD&lowast ; ; Takeshi Yamamoto ; MD&lowast ; ; Shinhiro Takeda ; MD&lowast ; ; Kengo Shigehara ; MD&Dagger ; ; Tsutomu Nomura ; MD&Dagger ; ; Akihiko Gamma ; MD&dagger ; ; Keiji Tanaka ; MD&lowast ;
- 关键词：chest pain ; differential diagnosis ; pleural effusion ; esophagography ; mortality ; Boerhaave syndrome
- 刊名：Journal of Emergency Medicine
- 出版年：2012
- 出版时间：December, 2012
- 年：2012
- 卷：43
- 期：6
- 页码：e419-e423
- 全文大小：273 K
Background
Boerhaave syndrome is a rare and often fatal syndrome. Delayed diagnosis and treatment is closely associated with prolonged morbidity and increased mortality. In general, esophagography is usually chosen as the diagnostic procedure, but it has a relatively high false-negative rate. There are no reports, to our knowledge, regarding the efficacy of thoracic drainage, although it is easier to perform and more immediate than esophagography in the emergency department.Objectives
To report the efficacy of thoracic drainage for rapid diagnosis and treatment of Boerhaave syndrome.
Case Report
An 80-year-old woman was admitted with vomiting and sudden onset of postprandial chest pain radiating to the back. Initially, myocardial infarction or aortic dissection was suspected, but was excluded by point-of-care tests and computed tomography (CT) scan, which revealed a left-sided pneumothorax, heterogeneous left pleural effusion, and pneumomediastinum at the lower level of the esophagus. Boerhaave syndrome was suspected and confirmed by thoracic drainage, which drained off bloody fluid and residual food such as broccoli. Emergency thoracotomy was performed within 4 h after onset of symptoms. The patient made an uneventful recovery.
Conclusion
Findings in this case indicate that chest pain, left-sided massive effusion on chest radiography, and left-sided massive heterogeneous effusion on CT scan are important for the diagnosis of Boerhaave syndrome. Subsequent thoracic drainage is useful for confirming Boerhaave syndrome, and such a strategy might lead to a good prognosis for patients with this rare but critical disease.