Levy F, Mysko W K, Kelen G D
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Emerg Med. 1995 May-Jun;13(3):321-5. doi: 10.1016/0736-4679(95)00015-3.
Boerhaave's Syndrome (spontaneous esophageal perforation) is an uncommon clinical entity that frequently presents with an antecedent history of marked vomiting followed by chest or abdominal pain. Misdiagnosis is the most important contributing factor in the continuing high morbidity and mortality of this disease. We report an atypical presentation of Boerhaave's Syndrome in an elderly female who presented to the Emergency Department with dyspnea, right sided chest pain, right pleural effusion, and hypovolemic shock without an identifiable antecedent event. A chest radiograph revealed massive right hydropneumothorax. After placement of a chest tube, the patient was admitted to the intensive care unit. Only 36 hours after admission did the diagnosis of Boerhaave's Syndrome become evident. She underwent operative repair and, after a prolonged stay, was discharged in relatively good condition 3 months after her admission. The absence of vomiting prior to presentation and the right sided effusion are the distinguishing features of this particular case.
博雷尔哈夫综合征（自发性食管穿孔）是一种罕见的临床病症，通常在剧烈呕吐病史后出现胸痛或腹痛。误诊是导致该疾病持续高发病率和高死亡率的最重要因素。我们报告了一例在急诊科就诊的老年女性博雷尔哈夫综合征的非典型表现，她表现为呼吸困难、右侧胸痛、右侧胸腔积液和低血容量性休克，且无明确的前驱事件。胸部X光片显示右侧大量液气胸。放置胸管后，患者被收入重症监护病房。入院仅36小时后，博雷尔哈夫综合征的诊断才明确。她接受了手术修复，经过长时间住院后，入院3个月后以相对良好的状态出院。就诊前无呕吐以及右侧积液是该特殊病例的显著特征。
