title: Chest pain, shock, and pneumomediastinum in a previously healthy 56-year-old man.
abstract: It is apparent from this discussion that it may be exceedingly difficult to make the diagnosis of Boerhaave's syndrome. The failure to correctly diagnose this patient was due, in part, to the absence of vomiting in the history. Nevertheless, the presence of pneumomediastinum on the initial chest roentgenogram was a significant finding that was missed and would have suggested this diagnosis. This patient is an example of an "atypical" presentation and demonstrates that vomiting need not be a part of the presentation. Because esophageal rupture is a rare clinical entity, a high index of suspicion and careful examination of the chest roentgenogram are mandatory to establish the correct diagnosis.
mesh_terms: D002637:Chest Pain / Q000150:complications*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D011859:Radiography; D012421:Rupture; D012769:Shock / Q000150:complications*