DIAGNOSTIC CONSIDERATIONS IN MEDIASTINAL EMPHYSEMA: A PATHOPHYSIOLOGIC-ROENTGENOLOGIC APPROACH TO BOERHAAVE’S SYNDROME AND SPONTANEOUS PNEUMOMEDIASTINUM

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Abstract
Spontaneous perforation of the esophagus and spontaneous pneumomediastinum are 2 infrequent causes of mediastinal emphysema. These 2 share many precursors: coughing, emesis, childbirth, defecation, status asthmaticus, convulsive seizures, and weight-lifting. They are at times difficult to distinguish on clinical grounds. A distinction can be made with confidence on chest roentgenograms and confirmed by a contrast medium swallow examination.Nine cases of Boerhaave’s syndrome and 4 cases of spontaneous pneumomediastinum are reviewed; the similarities and differences between the 2 emphasized; and studies on anatomic specimens are utilized to explain their pathophysiology. These studies are correlated with the roentgenographic findings.

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