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Oesophageal rupture masquerading as STEMI

Brian Skaug1, Kenneth R Taylor1, Somya Chandrasekaran2

  • 1University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.

BMJ Case Reports
|April 13, 2016
PubMed

Insights

A man presenting with chest pain was initially diagnosed with a heart attack but was found to have a distal esophageal rupture. This case underscores the importance of considering esophageal rupture in chest pain differentials.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Thoracic Surgery

Background:

  • Acute chest pain is a common emergency department presentation, often initially evaluated for myocardial infarction.
  • ST-elevation myocardial infarction (STEMI) protocols involve emergent cardiac catheterization to assess for obstructive coronary artery disease.

Observation:

  • A 67-year-old male presented with acute chest pain, exhibiting ECG changes suggestive of STEMI.
  • Coronary angiography revealed non-obstructive coronary disease.
  • Physical examination and imaging identified subcutaneous emphysema, pneumomediastinum, and a distal esophageal rupture.

Findings:

  • The patient underwent thoracotomy, chest tube placement, and esophageal stenting following stabilization.
  • Diagnosis of esophageal rupture was confirmed via CT scan.
  • Initial presentation mimicked acute myocardial infarction due to shared symptoms and ECG changes.

Implications:

  • Esophageal rupture should be considered in the differential diagnosis of acute chest pain, especially when cardiac workup is negative.
  • Multidisciplinary management involving critical care, thoracic surgery, and gastroenterology is crucial for esophageal rupture.
  • Prompt diagnosis and intervention are vital for improving outcomes in patients with esophageal rupture.

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