USMLE® Step 1 style questions USMLE
A 45-year-old woman begins complaining of chest pain in the post-anesthesia care unit after undergoing an upper endoscopy for evaluation of esophageal varices. She states the pain radiates to the back. She also complains of dyspnea, nausea, and she has produced blood-tinged vomitus. Past medical history is notable for chronic alcohol use disorder and liver cirrhosis. Her temperature is 37.5°C (99.5°F), blood pressure is 107/61 mmHg, and pulse is 82/min. Physical examination shows a woman in acute distress. Crackles are heard while auscultating over the heart. Abdominal exam is notable for hepatosplenomegaly. CT imaging reveals the following:
Reproduced from: Radiopedia
Which of the following is the most likely cause of this patient’s presentation?
Boerhaave syndrome, also called spontaneous esophageal rupture, is a rare but serious condition that occurs when the lining of the esophagus tears. This can happen after vomiting or coughing extremely hard. Boerhaave syndrome is a medical emergency and requires immediate treatment. If not treated quickly, Boerhaave syndrome can lead to death.