Radiological findings in Boerhaave's syndrome

Area of Science:

• Radiology
• Gastroenterology
• Thoracic Surgery

Background:

• Boerhaave's syndrome, a spontaneous esophageal perforation, presents diagnostic challenges.
• Accurate and timely diagnosis is critical for patient outcomes.

Purpose of the Study:

• To evaluate the diagnostic efficacy of chest radiography, esophagography, and computed tomography (CT) for Boerhaave's syndrome.
• To compare the sensitivity and specificity of these imaging modalities.

Main Methods:

• Retrospective review of CT findings in 14 patients with spontaneous esophageal perforation.
• Comparison of CT results with esophagography (n=11) and chest radiography (n=14).
• Analysis of unenhanced and contrast-enhanced CT scans, with oral contrast administration in some cases.

Main Results:

• Chest radiography showed pleural effusions (9/14) and infiltrates (9/14); CT demonstrated periesophageal air in all patients.
• Esophagography identified contrast extravasation (7/11) or submucosal collections (4/11).
• CT revealed periesophageal air tracks (all patients), pleural effusions (11/14), mediastinal fluid (7/14), and thickening of the esophageal wall (11/14).

Conclusions:

• CT is superior in diagnosing Boerhaave's syndrome by visualizing periesophageal air.
• CT should be a primary diagnostic tool in patients with suspected spontaneous esophageal perforation.
• CT offers comprehensive evaluation of associated complications like pneumothorax and mediastinal fluid.