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Boerhaave Syndrome With Alkaline Pleural Effusion

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Presentation on theme: "Boerhaave Syndrome With Alkaline Pleural Effusion"— Presentation transcript:

1 Boerhaave Syndrome With Alkaline Pleural Effusion
Kelechi Okoli, MD; Vamsee Marina, MD; Hussam Elkambergy, MD; Geetali Mohan, MD; Veejay Mahajan, MD OHIO THORACIC SOCIETY 57TH ANNUAL CONFERENCE 7 - 8 SEPTEMBER, 2007

2 Pleural Fluid pH in Esophageal Rupture
Gastric acid reflux1? Bacterial metabolism? Neutrophil metabolism2? Only elimination of neutrophils prevented fall in pH in experimental esophageal rupture Abbott OA, Mansour KA, Logan WD, et al: Atraumatic so-called "spontaneous" rupture of the esophagus. J Thorac Cardiovasc Surg 59:6742, 1970 Good JT Jr, Antony VB, Reller LB, Maulitz RM, Sahn SA. The pathogenesis of the low pleural fluid pH in esophageal rupture. Am Rev Respir Dis Jun;127(6):702-4

3 HPI 41 year-old type 1 diabetic Two days of nausea and vomiting
PMH: ESRD, CVA, PE Uremia. Hyperkalemia. DKA Hemodialysis and insulin Resolution of clinical and biochemical abnormalities

4 HPI On fifth hospital day, he vomited Acute dyspnea
BP 89/30mmHg; HR 128/min; RR 34/min; SaO2 83%; Temp 36.6oC Absent breath sounds over left hemithorax Portable CXR obtained

5 Intervention Left tube thoracostomy Left lung re-expansion
Persistent air leak Non-ionic contrast esophagogram

6 Pleural Fluid pH – 7.51 LDH – 184 IU/L Protein – 2.8 g/dL
Amylase – 2400 U/L No WBC seen Oral flora, Klebsiella, Haemophilus Blood . pH – 7.28 . LDH – 196 IU/L . Protein – 3.9 g/dL . WBC – 17.8 x 109 1. Corning pH meter

7 Outcome Left thoracotomy and decortication
2cm perforation in left posterolateral esophageal wall 3cm proximal to EGJ Complicated post-operative course Ventilator dependent Expired in palliative medicine unit

8 Conclusion Current case supports neutrophil metabolism
Temporal relationship between symptom onset and pleural fluid sampling should be considered when esophageal rupture is suspected

9 Abstract


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