June Case of the Month

Access case here.

Authors: Tony Alias, BS, Medical Student, Texas A&M School of Medicine, College Station, TX, Jessica A. Page, MD, PGY2, Radiology Resident, Department of Diagnostic Radiology, Texas A&M Health Sciences Center/Baylor Scott & White Health, Dallas, TX, and Richard E. Seggerman, MD, Body Imaging Division, Texas A&M Health Sciences Center/Baylor Scott & White Health, Dallas, TX

Why did you select this case for submission?

We felt it was a very good example of the classic imaging appearance of Boerhaave syndrome. In particular, we felt all of the typical plain-film findings of esophageal perforation and pneumomediastinum were very well demonstrated.

What should readers learn from this case?

Boerhaave syndrome is a surgical emergency with a high mortality rate if surgical intervention is not performed within the first 24 hours. Given the importance of making the correct diagnosis quickly, it is imperative that the radiologist be able to recognize the imaging findings typical of the syndrome. In particular, the ability to recognize the typical findings of esophageal perforation and pneumomediastinum on the initial chest radiograph can go a long way toward guiding the clinician down the right diagnostic path.

What did you learn from working on the case?

We learned the importance of early recognition of esophageal perforation, making correct recommendations involving both follow-up imaging and surgical consultation, as well as the importance of prompt verbal communication with clinicians to speed up the process of diagnosis and intervention.

How did guidance from senior staff at your institution impact your learning and case development?

Our radiology attending was involved throughout each step of the process, including presentation to the ER and both the initial and postoperative esophagrams. He discussed with us in detail the relevant imaging findings. With encouragement from our attending, the case was also made into a presentation that was shared with the other residents in our program.

Why did you choose Case in Point for submission of your case?

We felt that there were strong teaching points to be made and wanted to share those with others, and Case in Point is widely used by many of our colleagues. Therefore, we felt it would be the best platform for engaging a broad audience.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

Online learning, particularly case-based learning like Case in Point, tends to be more interactive than traditional textbook reading. One can test one’s knowledge on an actual case and obtain immediate feedback. More active engagement leads to better retention of learning material.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes, I and many of the residents I work with are regular readers and do Case in Point nearly every day. My favorite cases are usually ones that I feel would be most applicable to the cases I might be likely to come across on any given day, in particular acute presentations typical of the emergency setting.

Is there anything else you'd like readers to know about your case?

We continued to follow the patient throughout his hospital course. We performed an esophagram a few days after surgical repair, which showed no residual esophageal leak. The patient was discharged home in good condition 3 days later.

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