Boerhaave’s syndrome in an ultra-distance runner
The most common concern for athletes with chest pain is typically to evaluate them for cardiac causes. Boerhaave’s syndrome (effort induced oesophageal rupture) is a rare cause of chest pain and is typically seen in older patients.

A 37-year-old runner was competing in his first 100 mile race. He had not had any vomiting up to that point of the race. Soon after leaving, his pacer returned to the aid station requesting medical help: his runner was complaining of being unable to breathe and severe right-sided chest pain and right upper quadrant abdominal pain. His pain started after he took an over the counter non-steroidal anti-inflammatory pill. He never swallowed the pill because as soon as he took the pill, he immediately felt like he needed to vomit. On vomiting, he had severe pain to the point where the runner thought perhaps he had broken a rib.

Initial ECG was unremarkable. Laboratory evaluation showed an elevated white count of 17.8 K/μL with a left shift. Serum blood urea nitrogen was elevated at 50 with a creatinine of 2.3. Creatine phosphokinase was elevated at 5349 U/L and his brain natriuretic peptide level was also mildly elevated at 614 pg/dL. Troponin I was slightly elevated at 0.09 ng/mL and d-dimer was elevated at 598 ng/mL. A chest x-ray showed a large patchy infiltrate in the left lung base with no evident pleural effusion, pneumothorax or pulmonary oedema, along with pneumomediastinum with extensive dissection of soft tissue gas.

Source: BMJ case reports

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