What physical exam finding is associated with Boerhaave syndrome?

• A. Bradycardia
• B. Hammann's sign (crepitus from subcutaneous emphysema)
• C. Thrill in the abdominal area
• D. Positive Murphy's sign

Answer: (B)

Hammann's sign is characterized by a crunching or crepitant sound that is synchronous with the heartbeat, and it occurs due to the presence of air in the mediastinum—this condition is known as pneumomediastinum. In Boerhaave syndrome, which is an esophageal rupture, air can escape from the esophagus into the surrounding tissues, leading to subcutaneous emphysema and thus producing Hammann's sign upon auscultation. This sign serves as an important clinical clue that can aid in the diagnosis of this potentially life-threatening condition.

The presence of bradycardia is not typically associated with Boerhaave syndrome; instead, patients may present with tachycardia due to pain or distress. A thrill in the abdominal area usually suggests a vascular issue or a significant fluid collection but is not relevant in the context of esophageal rupture. Positive Murphy's sign indicates gallbladder inflammation or problems related to the liver or biliary system, which is unrelated to the rupture of the esophagus. Understanding Hammann's sign and the mechanisms behind it is essential for recognizing esophageal rupture and promptly managing Boerhaave syndrome.