Radiological findings in Boerhaave's syndrome.

Abstract

The aim was to define the diagnostic value of chest radiography, esophagography, and computed tomography (CT) in patients with Boerhaave's syndrome. CT findings in 14 patients (11 male, 3 female; mean age: 60 years; median age: 66 years; age range: 36-78 years) with spontaneous esophageal perforation were retrospectively reviewed and compared to those of esophagography ( n=11) and chest radiography ( n=14). In six patients unenhanced CT scans were available; in ten patients (2/10 patients had an unenhanced CT before) a contrast-enhanced CT was performed as an emergency investigation. In 5/14 patients additional oral contrast medium was given. Chest radiography revealed pleural effusions in 9/14 and infiltrates in 9/14 patients. Pneumothorax and pneumopericardium were observed in two patients each. Pneumomediastinum was seen in three patients. Two chest radiographs were normal. Esophagography performed in 11 patients demonstrated contrast medium extravasation at a supradiaphragmatic level in seven patients, indicating esophageal perforation with esophagopleural fistula, and a submucosal contrast medium collection in four cases. Unenhanced CT scans revealed four intramural hematomas with typical localization. Unenhanced and contrast-enhanced CT demonstrated periesophageal air collections indicating esophageal perforation in all patients. Pleural effusions were seen in 11/14 and infiltrates in 8/14 patients. Contrast medium extravasation was observed in 5/14 patients, whereas a thickening of the esophageal wall was depicted in 11/14 patients. Periaortic air tracks ( n=7), pneumothorax ( n=3), pneumomediastinum ( n=6), and mediastinal fluid collections ( n=7) were depicted in CT. By demonstrating periesophageal air tracks suggestive of esophageal perforation, CT reveals the decisive criteria for diagnosing Boerhaave's syndrome and should therefore be performed in the diagnostic work-up of patients in whom this syndrome is part of the differential diagnosis.