Urgent Investigation in Suspected Boerhaave Syndrome
| Test | Comment |
|---|---|
| Chest X-ray | Almost always abnormal in Boerhaave syndrome although changes may be subtle at presentation. Abnormalities seen include pneumomediastinum, mediastinal widening, subcutaneous emphysema, pleural effusion (usually on left), pneumothorax, free peritoneal gas. |
| CT chest | Indicated if chest X-ray is non-diagnostic and other diagnoses such as aortic dissection or pulmonary embolism are more likely. In Boerhaave syndrome, CT may show extra-oesophageal gas, peri-oesophageal fluid, mediastinal widening, and gas and fluid in pleural spaces, retroperitoneum and lesser sac. |
| Water-soluble (Gastrografin) contrast swallow | Definitive test. Reveals location and extent of extravasation of contrast medium. If negative despite high clinical index of suspicion, barium swallow should be done. |
| Aspiration of pleural effusion if present | Exudative pleural effusion with low pH, high amylase level, purulent; may contain undigested food. |
| Tests to exclude other diagnoses and needed in management | ECG, arterial blood gases and pH, full blood count, group and screen, biochemistry, blood culture. |