title: A case of rapid diagnosis of Boerhaave syndrome by thoracic drainage.
abstract: 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.
  
  
  OBJECTIVE
  To report the efficacy of thoracic drainage for rapid diagnosis and treatment of Boerhaave syndrome.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Intensive and Cardiac Care Unit, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Suzuki
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Junya
authors.initials: J
authors.lastname: Matsuda
authors.forename: Naoya
authors.initials: N
authors.lastname: Niwa
authors.forename: Koji
authors.initials: K
authors.lastname: Murai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Shinhiro
authors.initials: S
authors.lastname: Takeda
authors.forename: Kengo
authors.initials: K
authors.lastname: Shigehara
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nomura
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gamma
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000369:Aged, 80 and over; D002637:Chest Pain / Q000150:complications; D015505:Chest Tubes; D003937:Diagnosis, Differential; D004322:Drainage; D004939:Esophageal Perforation / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D008477:Mediastinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008478:Mediastinal Emphysema / Q000150:complications / Q000628:therapy; D010996:Pleural Effusion / Q000150:complications / Q000628:therapy; D011030:Pneumothorax / Q000150:complications / Q000628:therapy; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation