Diagnosis

The diagnosis of Boerhaave's syndrome is made after:

• chest X-ray:
  • after a few hours, air and fluid in the pleural cavity
  • mediastinal emphysema
  • in up to 20% of cases, the 'Nacleario V-sign' may be seen as radiolucent streaks that dissect the retrocardiac fascia to form the letter V. This is a specific but insensitive radiographic sign of oesophageal perforation.
• contrast studies: definitive diagnosis made with gastrograffin swallow to show the site of the perforation
• CT scanning. CT findings may include periesophageal and mediastinal gas, mediastinal fluid collections, oesophageal wall thickening, pleural effusion, pneumothorax, and hydrothorax. (1)

Reference

1. Tonolini M, Bianco R. Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography. J Emerg Trauma Shock. 2013 Jan;6(1):58-60.