title: Boerhaave Syndrome Presenting as Tension Pneumothorax: First Reported North American Case.
abstract: Tension pneumothorax is a rare and potentially life-threatening clinical complication. A 43-year-old Caucasian woman with type 1 diabetes mellitus presented with nausea and retching and examination revealed dehydration. Laboratory parameters were consistent with a diagnosis of diabetic ketoacidosis, which responded to therapy. Suddenly, 30 hours later, she developed cardiorespiratory compromise due to a tension pneumothorax. After emergent decompression and catheter placement, computerized tomographic scan of the chest demonstrated esophageal-pleural fistula confirming Boerhaave syndrome as the etiology for the pneumothorax. The patient underwent emergent esophagectomy with pleural washout with a subsequent gastric pull-up surgery. Boerhaave syndrome frequently presents atypically with chest pain, dyspnea, and nausea. It communicates with the left pleural space in 80% to 90% of cases, but <5% of cases involve the right pleural cavity. Unexplained and rapidly progressive pleural effusions have been associated with this entity. Only 4 cases of Boerhaave syndrome causing tension pneumothorax have been reported in the literature so far.
authors.affiliation: Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Saraschandra
authors.initials: S
authors.lastname: Vallabhajosyula
authors.affiliation: Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Pranathi R
authors.initials: PR
authors.lastname: Sundaragiri
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA ilyaberim@creighton.edu.
authors.forename: Ilya G
authors.initials: IG
authors.lastname: Berim
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods*; D004937:Esophageal Fistula / Q000000981:diagnostic imaging* / Q000601:surgery; D004939:Esophageal Perforation / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D005743:Gastrectomy; D006801:Humans; D008477:Mediastinal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D009102:Multiple Organ Failure / Q000628:therapy*; D035422:Pleural Cavity / Q000000981:diagnostic imaging* / Q000473:pathology; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation
chemical_list: D000900:Anti-Bacterial Agents
keywords: Barrett esophagus; Boerhaave syndrome; esophagopleural fistula; shock; tension pneumothorax