Douleur thoracique et vomissement: attention au syndrome de boerhaave

ALLONNEAU A, LEFORT H, MICHEL-MLYNSKI AC, JOST D, TOURTIER JP. Chest pain and vomiting: Beware of Boerhaave syndrome. Med Emergency, MJEM 2016; 24:22-5.

Mots clés : douleur thoracique, dyspnée, emphysème sous cutané, syndrome de Boerhaave, triade de Mackler, vomissement
Key words: Boerhaave syndrome, Chest pain, dyspnea, Mackler’s triad, Subcutaneous emphysema, vomiting
  • Authors’ affiliation
  • Article history / info
  • Conflict of interest statement
Correspondent author: Hugues LEFORT, MD

Emergency Medicine Department, Fire Brigade of Paris, 1 place Jules Renard, 75017 Paris, France

hdlefort@gmail.com

Allonneau A, MD, Lefort H, MD, Michel-Mlynski AC, MD, Jost D, MD, Tourtier JP, MD, PhD

Emergency Medicine Department, Fire Brigade of Paris, 1 place Jules Renard, 75017 Paris, France

Category: Case report

Received: Aug. 19, 2015

Revised: Sept. 09, 2015

Accepted: Sept. 30, 2015

There is no conflict of interest to declare

ABSTRACT

Boerhaave syndrome is a rare cause of chest pain that is difficult to diagnose and that can and can be life threatening. It corresponds to an esophageal rupture as a result of a sharp increase in esophageal pressure. We report the case of a 74 year old patient victim of dyspnea associated with left/posterior latero-thoracic oppressive pain, after repeated attempts to vomiting. The diagnosis was chosen after performing chest radiography followed by thoraco-abdominal scanner that was able to highlight a left pneumothorax and pneumomediastinum associated with bilateral pleural effusion. Mackler’s triad characteristic of this syndrome, which combines vomiting, chest pain and subcutaneous emphysema, is inconsistent. Further tests are then crucial especially along with thoracoabdominal scanner. The combined advancement of medical imaging and surgical techniques have greatly improved the prognosis of these patients especially in case of early treatment.

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