[Early diagnosis and treatment of Boerhaave's syndrome is pivotal for the prognosis].

Hydropneumothorax following oesophageal rupture is very rare and often lethal. We report case of a 78-year-old man with known Barret's oesophagus with increasing shortness of breath and right chest pain followed by increasing emesis. Further investigations showed a right side hydropneumothorax and pleural effusion. Thorax and abdominal CT showed middle oesophageal perforation and pneumomediastinum. Oesophageal perforation can lead to pneumothorax and pleural fluid. Early diagnosis is pivotal to reduce mortality.