An Unusual Case of Chest Pain

Abstract

A 25 year old female from Palakkad was referred to our hospital with a/c onset of difficulty in swallowing and diffuse chest pain of one day duration. There was radiation of pain to right side of neck and right arm. Prior to this she had fever and cough with persistent vomiting for 3 days. Chest X ray showed subcutaneous emphysema on the right side with evidence of pneumomediastinum. Barium swallow done once the patient became symptomatically better, showed evidence of contrast leak.

Boerhaave's syndrome is a transmural perforation of the oesophagus following a forceful emesis. The Meckler's triad defines the classic presentation of Boerhaave syndrome. It is the triad of vomiting, lower thoracic chest pain and subcutaneous emphysema