Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6192-6197
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6192
Presentation of Boerhaave’s syndrome as an upper-esophageal perforation associated with a right-sided pleural effusion: A case report
Ni Tan, Yin-Hua Luo, Guang-Cai Li, Yi-Lin Chen, Wei Tan, Yue-Hua Xiang, Liang Ge, Di Yao, Ming-Hua Zhang
Ni Tan, Guang-Cai Li, Yi-Lin Chen, Wei Tan, Yue-Hua Xiang, Liang Ge, Di Yao, Ming-Hua Zhang, Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
Yin-Hua Luo, Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
Author contributions: All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Supported by the Natural Science Foundation of Hubei Province, No. 2019CFB798.
Informed consent statement: The patient has provided informed consent for publication of the case. A copy of the written consent is available for review from the Editor-in-Chief of this journal.
Conflict-of-interest statement: The authors have no conflicts of interest in relation to this work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Hua Zhang, MD, Chief Doctor, Doctor, Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Blog 158, WuYang, Street, Enshi Autonomous Prefecture 445000, Hubei Province, China. 1115295145@qq.com
Received: November 7, 2021
Peer-review started: November 7, 2021
First decision: January 11, 2022
Revised: January 18, 2022
Accepted: April 29, 2022
Article in press: April 29, 2022
Published online: June 26, 2022
Abstract
BACKGROUND

Spontaneous esophageal rupture or Boerhaave's syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality. Here, we aimed to explore the clinical characteristics, diagnosis, treatment, and prognosis of spontaneous esophageal rupture, and to analyze the causes of misdiagnosis during the treatment of spontaneous esophageal rupture.

CASE SUMMARY

The clinical features of the patient with spontaneous esophageal rupture misdiagnosed earlier as pleural effusion were retrospectively analyzed and the reasons for misdiagnosis are discussed based on a current review of the literature. The patient was admitted to a local hospital due to shortness of breath accompanied by vomiting and abdominal distension for five hours. Based on the computed tomography (CT) scan analysis, clinically, right pleural effusion was diagnosed. However, the patient was unwilling to undergo right closed thoracic drainage. The patient also had intermittent fevers against infection, and during the course of treatment, he complained of chest pain, following which, he was transferred to our hospital. Grapefruit-like residue drainage fluid was observed. Re-examination of the chest CT scans suggested the presence of spontaneous perforation in the upper left esophagus. Therefore, the patient underwent an urgent esophageal hiatus repair. Unfortunately, the patient died of infection and respiratory failure due to progressive dyspnea after surgery.

CONCLUSION

Spontaneous esophageal rupture is a rare disease associated with high fatality. The patients do not present typical clinical symptoms and the disease progresses rapidly. This case report highlights the importance of a dynamic review of chest CT scan, not only for the initial identification of segmental injury but also for prioritizing subsequent treatment strategies. Moreover, we have presented some clues for clinicians to recognize and diagnose spontaneous esophageal rupture at rare sites (upper-esophageal segment) through this case report of spontaneous esophageal rupture that caused the patient's death. We have also summarized the reasons for the misdiagnosis and lessons learned.

Keywords: Spontaneous esophageal rupture, Chest computed tomography, Upper-esophageal perforation, Right-sided pleural effusion, Misdiagnosis, Case report

Core Tip: Spontaneous esophageal rupture is a rare disease associated with high fatality. We report a case of spontaneous esophageal rupture misdiagnosed earlier as pleural effusion at an early stage and investigated the causes of its misdiagnosis, along with our experience during diagnosis and treatment. This case report also highlights the importance of a dynamic chest computed tomography review, not only for initial identification of the injured segment but also for prioritizing subsequent treatment strategies. Moreover, we also provide clues for clinicians to recognize and diagnose spontaneous esophageal rupture at a rare site (upper-esophageal segment) by reporting this case.