December 2017 Critical Care Case of the Month
Saturday, December 2, 2017 at 8:00AM
Rick Robbins, M.D. in Boerhaave's, CT scan, chest pain, contrast, differential diagnosis, esophageal rupture, esophogram, retching, vomiting, water soluble

Michael B. Gotway, MD


Department of Radiology

Mayo Clinic Arizona

Scottsdale AZ USA


Clinical History: A 57-year-old man with no known previous medical history was brought to the emergency room via ambulance and admitted to the intensive care unit with a compliant of severe chest pain in the substernal region and epigastrium. The patient was awake and alert and did not complain of shortness of breath.

Physical examination was largely unremarkable and the patient’s oxygen saturation was 98% on room air. The patient’s vital signs revealed tachycardia (105 bpm) and his blood pressure was 108 mmHg / 60 mmHg.

Laboratory evaluation showed a slightly elevated white blood cell count (13 x 109 cells/L), but his hemoglobin and hematocrit values were with within normal limits, as was his platelet count. 

Which of the following diagnoses are appropriate considerations for this patient’s condition? (Click on the correct answer to proceed to the second of nine pages)

  1. Acute pericarditis
  2. Aortic dissection
  3. Community-acquired pneumonia
  4. Myocardial infarction
  5. All of the above

Cite as: Gotway MB. December 2017 critical care case of the month. Southwest J Pulm Crit Care. 2017;15(6):241-52. doi: PDF 

Article originally appeared on SOUTHWEST JOURNAL of PULMONARY & CRITICAL CARE (
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