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Boerhaave's syndrome presenting as a right-sided pleural effusion
S T Yang1, A Devanand, K L Tan
1Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore 169608. gm3yty@sgh.com.sg
Introduction:
Boerhaave's syndrome is an uncommon condition where there is oesophageal rupture following forceful vomiting, subsequent mediastinitis and is associated with high mortality and morbidity in the absence of therapy. We present a case of Boerhaave's syndrome in a 79-year-old woman who developed a right-sided effusion, an unusual presentation.
Clinical Picture:
A 79-year-old woman developed a right-sided empyema and mediastinitis after a bout of repeated vomiting. Gastrograffin swallows and oesophago-gastroduodenoscopy confirmed oesophageal rupture.
Treatment:
The patient was treated with antibiotics and a tube thoracostomy. An open thoracotomy, oesophagostomy and thoracic window was subsequently performed.
Outcome:
The oesophageal rupture was contained but patient died from postoperative complications.
Conclusions:
Physicians should have a high index of suspicion of oesophageal rupture when patients present with Meckler's triad of symptoms and especially when pleural fluid cultures grow bacteria native to the gastrointestinal tract.