What imaging study is preferred for diagnosing Boerhaave syndrome?

• A. CT scan with contrast
• B. Gastrografin swallow
• C. Barium swallow
• D. X-ray plain film

Answer: (B)

The preferred imaging study for diagnosing Boerhaave syndrome is a Gastrografin swallow. This technique is particularly beneficial because it utilizes a water-soluble contrast agent, which helps to identify any perforations in the esophagus without the high risk of causing complications that a barium swallow might present if a perforation is present.

In cases of Boerhaave syndrome, which involves a rupture of the esophagus due to severe vomiting or other trauma, it is crucial to avoid using barium as it can lead to inflammatory reactions in the mediastinum and worsen the patient's condition. Instead, Gastrografin, being water-soluble, can safely outline any esophageal tears and help direct appropriate surgical management if necessary.

CT scans with contrast can also be useful for evaluating complications associated with esophageal perforation, such as pleural effusions or mediastinal air, but they are not the primary diagnostic tool for Boerhaave syndrome itself. Plain films, meanwhile, are less sensitive and can easily miss subtle signs of perforation.