Esophageal Rupture

Break

Step 1: View clinicals

A 54 year old man presents with severe central chest pain for 2 hours, which was acute in onset and is associated with nausea, vomiting and sweating. His medical and family histories are unremarkable. He is a social drinker only and does not smoke. A recent check up showed a normal fasting blood glucose, lipid profile, renal and liver functions. Serial ECGs show sinus tachycardia only, while troponin-I levels are within normal limits.


Step 2: Order all relevant investigations

Serum Amylase + Lipase

S. Amylase : 47 U/l (range: 23 - 85) S. Lipase : 15 U/l (range: 7 - 60)

Echocardiogram

The echocardiogram shows no structural cardiac defects or wall motion abnormalities. The right ventricle is not dilated and shows normal function. The left ventricular ejection fraction is 65%. The thoracic aorta appears normal.

Chest X-Ray

The chest x-ray shows air in the mediastinum and a small right sided pleural effusion. There is no air under the diaphragm.

Gastrografin swallow

The gastrografin swallow test shows extravasation of contrast from the right lower esophagus into the right pleural cavity.


Step 3: Select appropriate management

Thrombolysis
IV Antibiotics
IV Beta-blockers
Surgery


Score: ★★☆