Boerhaave's syndrome presented with right-sided hydropneumothorax and hoarseness of voice: A case report

Boerhaave's syndrome is a rare and sometimes life-threatening condition characterized by lower esophageal tear due to a sudden rise of intraluminal pressure, and it is usually presented with a history of forceful vomiting, abdominal or chest pain, and sometimes subcutaneous emphysema. Atypical and delayed presentation is also not uncommon. A high index of suspicion is needed for diagnosis. The diagnosis is confirmed by contrast esophagogram or contrast computed tomography (CT) of the chest. Mortality rates could be as high as nearly 20-40% even in the treated cases. In this article, we report a case of a 57-year-old male, who is a smoker as well as an alcoholic, with right-sided hydropneumothorax presenting with dyspnea, epigastric pain, hoarseness of voice, and features of shock. Boerhaave's syndrome was suspected on finding food particles in pleural fluid that contained very high salivary amylase level. The diagnosis was confirmed with a sterile methylene blue contrast study.