1. 64 Y / O M WITH SEVERE EPIGASTRIC PAIN N ICK S HAH S EPTEMBER 27, 2013 U RVI T AILOR, MD P AUL L EWIS, MD

2. 64 y/o M PMH: esophageal stricture s/p balloon dilation Took fiber pill, felt “stuck” → tried to vomit Immediate, 10/10, tearing, radiating to back Physical: +crepitus in neck and chest H ISTORY & P HYSICAL

3. Boerhaave’s Syndrome Mallory-Weiss Tear Aortic Dissection MI D IFFERENTIAL D IAGNOSES

4. Upright CXR Esophagram CT Chest, Abdomen O PTIONS FOR D IAGNOSTIC I MAGING

5. ACR A PPROPRIATENESS C RITERIA

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16. Spontaneous perforation of the thoracic esophagus due to sudden increase in intraluminal esophageal pressure Radiographic features – Pneumomediastinum – Pleural Effusion L > R – Mediastinal hematoma – Rupture immediately above diaphragm Left posteriolateral side (90%) Source: Primer of Diagnostic Imaging, 5 th ed B OERHAAVE ' S S YNDROME

17. Left thoracotomy with primary repair of esophageal perforation Discharged POD#7 T REATMENT & F OLLOW - UP

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33. End. Thank you.