Schwartz J A, Turnbull T L, Dymowski J, Uehara D T
Am J Emerg Med. 1986 Nov;4(6):532-6. doi: 10.1016/S0735-6757(86)80012-2.
Boerhaave's syndrome represents a diagnostic dilemma for the emergency physician. The prognosis of this truly life-threatening emergency is darkened by any significant diagnostic delay. Unfortunately, classic or expected symptoms and signs are frequently absent at presentation, a circumstance that leads to frequent misdiagnosis. Two cases of Boerhaave's syndrome with "atypical" clinical presentations are reviewed and discussed. It is clear that Boerhaave's syndrome should always be suspected in the evaluation of any sudden chest, abdominal, or back pain associated with emesis. However, emphasis should be placed on the fact that this entity may occur without emesis. The chest radiograph is the most helpful diagnostic aid. Undoubtedly, maintenance of a high degree of suspicion by the emergency physician for Boerhaave's syndrome will lead consistently to earlier diagnosis, and subsequent aggressive intervention should result in considerable reduction in rates of both morbidity and mortality.
博雷尔哈夫综合征对急诊医生来说是一个诊断难题。这种真正危及生命的急症，任何显著的诊断延迟都会使其预后恶化。不幸的是，典型或预期的症状和体征在就诊时常常不存在，这种情况导致频繁误诊。本文回顾并讨论了两例具有“非典型”临床表现的博雷尔哈夫综合征病例。显然，在评估任何与呕吐相关的突发胸痛、腹痛或背痛时，都应始终怀疑博雷尔哈夫综合征。然而，应该强调的是，这种病症可能在没有呕吐的情况下发生。胸部X光片是最有用的诊断辅助手段。毫无疑问，急诊医生对博雷尔哈夫综合征保持高度怀疑将始终能实现更早的诊断，而随后的积极干预应能大幅降低发病率和死亡率。
