# Mediastinal hematoma as an unusual intrathoracic manifestation of Boerhaave Syndrome: A case report

## TL;DR

A rare case of Boerhaave Syndrome presented as a mediastinal hematoma, highlighting the importance of timely diagnosis and surgery to prevent fatal outcomes.

## Contribution

This case report demonstrates that Boerhaave Syndrome can manifest as a mediastinal hematoma without immediate bacterial contamination.

## Key findings

- Boerhaave Syndrome can present as a mediastinal hematoma due to arterial injury.
- A mediastinal hematoma can be fatal even before bacterial contamination occurs.
- Timely surgical intervention is critical in managing Boerhaave Syndrome cases.

## Abstract

Boerhaave Syndrome (BS) is rare but life-threatening condition caused by a sudden increase in the intraluminal pressure due to vomiting. We present a case of BS manifesting as a posterior mediastinal hematoma, indicative of a potentially fatal condition.

A 51-year-old man presented with acute chest pain after vomiting. Enhanced Computed Tomography revealed mediastinal fluid with a left pleural effusion, leading to a diagnosis of BS. Emergency surgery revealed a posterior mediastinal hematoma with active bleeding due to a torn proper esophageal artery. Hemostasis and a wall repair were performed, and the patient was discharged uneventfully.

This case highlights two important aspects. Firstly, a spontaneous esophageal perforation can manifest as a mediastinal hematoma due to the subpleural arterial injury, delaying bacterial spillage. While preoperative thoracentesis may not always diagnose BS accurately, bloody thoracic drainage can serve as an alternative diagnostic sign. Secondly, the mediastinal hematoma itself poses a serious risk, as it can lead to a catastrophic outcome even before bacterial contamination occurs, emphasizing the necessity of a timely surgical intervention in BS cases.

BS can manifest as a mediastinal hematoma, and the absence of gastrointestinal content in the thoracic drainage does not rule out the possibility of BS. Prompt surgical intervention remains essential, as a mediastinal hematoma alone can result in a catastrophic outcome. This case highlights the significance of a comprehensive diagnostic assessment for BS.

•Boerhaave Syndrome can manifest as a rare mediastinal hematoma.•A mediastinal hematoma itself can result in a catastrophic outcome even before the bacterial spillage becomes evident.•This report highlights the significance of a comprehensive diagnosis and timely surgical intervention for Boerhaave Syndrome.

Boerhaave Syndrome can manifest as a rare mediastinal hematoma.

A mediastinal hematoma itself can result in a catastrophic outcome even before the bacterial spillage becomes evident.

This report highlights the significance of a comprehensive diagnosis and timely surgical intervention for Boerhaave Syndrome.