title: Ruptured celiac artery aneurysm mimicking Boerhaave syndrome.
abstract: Ruptured celiac artery aneurysm is a rare cause for epigastric pain and is usually detected incidentally. Atypical presentation with postemetic epigastralgia and pleural effusion usually leads physicians to make the diagnosis of Boerhaave syndrome. Herein, we report a 32-year-old woman who was diagnosed with Boerhaave syndrome initially after presenting with acute postemetic epigastralgia and predominant left side pleural effusion. Diagnostic left thoracentesis yielded bloody fluid with similar amylase level to serum. The chest computed tomographic scan showed no evidence of esophageal rupture. However, a ruptured celiac artery aneurysm with retroperitoneal hematoma extending to the posterior mediastinum and bilateral pleural space was found incidentally. Although ruptured celiac artery aneurysm is an uncommon cause for postemetic epigastralgia, acute vascular events such as the previously stated cause should be the first impression rather than Boerhaave syndrome if the patient also presents with isolated pleural effusion containing unelevated amylase.
authors.affiliation: Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Liu
authors.forename: Kai-Wei
authors.initials: KW
authors.lastname: Yang
authors.forename: Wei-Kung
authors.initials: WK
authors.lastname: Chen
authors.forename: Chen-Hsiung
authors.initials: CH
authors.lastname: Huang
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002445:Celiac Artery / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D004939:Esophageal Perforation / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008477:Mediastinal Diseases / Q000175:diagnosis*; D010996:Pleural Effusion / Q000209:etiology; D014057:Tomography, X-Ray Computed; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation