Boerhaave syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2]

Overview

Physical examination

Appearance of the Patient

The patient might be in moderate distress with epigastric pain and bleeding.

Vital Signs

Skin

HEENT

  • Normal

Neck

  • Low Jugular venous pressure

Lungs

  • Normal/Subcutaneous emphysema
  • Pneumomediastinum may cause a crackling sound on chest auscultation, known as the Hamman crunch.

Heart

Abdomen

  • Normal/Abdominal rigidity

Back

  • Normal

Extremities

  • Normal

Genitourinary

  • Normal

Neuromuscular

  • Normal

Physical examination is usually not helpful, particularly early in the course. Subcutaneous emphysema (crepitation) is an important diagnostic finding but is not very sensitive, being present in only 9 of 34 patients (27 percent) in one series . A pleural effusion may be detected. A case report described presentation with an Enterococcal bacterial pericardial effusion.

References

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