madhurima
AIPPG Experienced Senior Member
Joined: 06 Nov 2008
Posts: 2534
85332 Credits
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 Posted: Mon Nov 02, 2009 2:24 pm Post subject: 32 yo m develops severe nausea and vomitting after returning |
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32 yo m develops severe nausea and vomitting after returning from a party. He also c/o chest pain that is more intense than any pain he has previously experienced. His PMH is HIV infection, alcohol abuse and alcoholic hepatitis. He admits using cocaine regularly. His temp is 100 deg F, pulse 120/min, resp 24/min, BP 100/60. Physical examinatino reveals, injected conjunctivae, and bilateral dilated pupils. CXR demonstrates a widened mediastinum and left sided pleural effusion. EKG is unremarkable. The pleural fluid is found to have an elevated amylase content. Which of the following is most likely diagnosis in this patient?
a. Acute pancreatitis
b. Peptic ulcer disease
c. Pneumonia
d. DM
e. Pulmonary embolism
f. Esophageal perforation
g. Aortic dissection
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madhurima
AIPPG Experienced Senior Member
Joined: 06 Nov 2008
Posts: 2534
85332 Credits
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| Posted: Mon Nov 02, 2009 2:25 pm Post subject: |
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The patient is presenting with a spontaneous esophageal rupture or Brerhave's syndrome. The classic presentation is acute severe chest or epigastric pain after an episode of retching. On examination, subcutaneous emphysema, pleural effusion, mediastinal widening, pleural fluid will have high amylase concentration, low pH, may contain particles of food.
(A) Acute pancreatitis can cause a unilateral left sided effusion with a high amylase concentration. However, pancreatitis should not cause widening of mediastinum. And pain usually radiates to back.
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