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

The patient might be in moderate distress with epigastric pain and bleeding. Patients may experience Tachycardia, weak pulse, hypotension, Diaphoresis and fever.

Physical examination

Appearance of the Patient

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

Vital Signs

• Tachycardia
• Weak pulse
• Hypotension
• Diaphoresis
• Fever

Skin

• Pallor

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

• Tachycardia

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.