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]

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.