Boerhaave syndrome chest x ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2], Shaghayegh Habibi, M.D.[3], Ajay Gade MD[4]], Feham Tariq, MD [5]

An upright anterior-posterior view of the chest is the most useful in early diagnosis. In most patients with Boerhaave syndrome (BHS) chest x-ray shows one-sided effusion, pneumothorax, hydropneumothorax, pneumomediastinum and subcutaneous emphysema.

• An upright anterior-posterior view of the chest is the most useful in early diagnosis, as most of the patients will reveal an abnormal chest finding after the perforation.
• The Naclerio V-sign may be seen on chest radiograph as radiolucent streaks of air seen in the retro-cardiac region in the V shape.^[1]

The usual although unspecific radiographic features of BHS include:^[2]

• One-sided effusion (usually on the left)
• Lung infiltrates
• Atelectasis

Whereas more specific signs are rarely detected or very subtle:^[1][3][2]

• Pneumothorax
• Hydropneumothorax
• Pneumomediastinum
• Mediastinal widening
• Pneumopericardium
• Subcutaneous emphysema

• 
  Chest X-ray: Frontal view reveals pneumomediastinum (black arrows). Subcutaneous emphysema (red arrow) along the chest wall, more prominent along the right than left; Source- Radiopaedia
• 
  Chest X-ray: Boerhaave syndrome- Lateral radiographs subcutaneous emphysema (red arrow) along the chest wall; Source- Radiopaedia

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