Chest Pain After Vomiting: Recognizing Boerhaave Syndrome in the Emergency Department

Boerhaave syndrome is a rare but potentially fatal condition characterized by spontaneous transmural rupture of the esophagus, most often triggered by a sudden rise in intraluminal pressure against a closed glottis following forceful retching. Its clinical presentation can mimic other life‑threatening thoracic emergencies such as myocardial infarction, pulmonary embolism, or aortic dissection. A 50-year-old man presented to the Emergency Department with sudden onset of severe central chest pain radiating to the left side associated with shortness of breath, following multiple episodes of forceful vomiting. On examination, he was hemodynamically stable. Chest and soft-tissue neck radiographs demonstrated surgical emphysema, and a contrast-enhanced CT scan of the chest confirmed esophageal rupture with extraluminal air and food residue. The patient was managed with intravenous fluids, broad-spectrum antibiotics, and urgent cardiothoracic referral for definitive management. This case highlights the importance of maintaining a high index of suspicion for Boerhaave syndrome in patients presenting with chest pain following episodes of forceful vomiting, as early recognition and prompt intervention are vital to reduce morbidity and mortality.