Boerhaave's

Clinical

Boerhaave's syndrome or spontaneous esophageal perforation occurs when a sudden increase in intraluminal esophageal pressure causes a full thickness perforation. Mediastinitis, sepsis, and shock can occur subsequently. Most cases of Boerhaave's are due to violent retching or vomiting after an alcoholic binges. However, some cases can occur after other causes of increased intraluminal pressure-i.e. coughing, weightlifting, defecation, childbirth, seizures or blunt trauma.

Radiological findings

The perforations are vertically oriented and usually occur as 1 to 4cm linear tears on the left posterolateral wall of the esophagus just above the gastroesophageal junction. The distal esophagus is vulnerable because it lacks the supporting mediastinal structures and left side is too because the right side is protected by the descending aorta. Findings are plain film and contrast studies are similar to those found on thoracic esophageal perforations.

These images on esophagram depict contrast extravasation from the distal esophagus in a patient with spontaneous perforation of the esophagus.