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Revista Clínica de Medicina de Familia

On-line version ISSN 2386-8201Print version ISSN 1699-695X

Abstract

MARIN ORTEGA, Héctor; MARTINEZ RODRIGUEZ, Iñaki; MIFSUT PORCEL, Patricia  and  AGIRRE ETXABE, Leire. Spontaneous pneumomediastinum with suspected Boerhaave's syndrome. Rev Clin Med Fam [online]. 2012, vol.5, n.3, pp.209-211. ISSN 2386-8201.  http://dx.doi.org/10.4321/S1699-695X2012000300011.

Spontaneous pneumomediastinum is a rare entity, defined by the presence of air in the mediastinum of neither iatrogenic nor traumatic origin. It usually affects patients in the paediatric age group, usually associated with asthmatic crisis. Other triggers are Vasalva, strenuous exercise, vomiting, diabetic ketoacidosis or drug abuse. Clinically, the association of chest pain and dyspnea is typical, and is generally a benign process which is cleared up by conservative treatment. However, its clinical presentation is often more confusing in adolescent and adult patients, where it is sometimes indistinguishable from spontaneous oesophageal rupture ( Boerhaave's syndrome), with an accurate differential diagnosis between the two entities being crucial, given the different therapeutic and prognostic implications, as in the case presented. The clinical presentation can be identical. Nevertheless, patients with oesophageal perforation tend towards progressive sepsis, with high rates of mortality if diagnosis is delayed. In our case, the patient's appearance, leukocytosis, abdominal pain and compatible history made us consider that possibility. As long as suspicion of oesophageal perforation exists, it is recommended to perform diagnostic tests, of which a CT scan with water-soluble oral contrast is the one of choice, as it allows assessment of the oesophageal wall and presence of associated collections of fluid.

Keywords : Thoracic Pain; Mediastinal emphysema; Subcutaneous emphysema; Spontaneous perforation of the esophagus.

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