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Boerhaave Syndrome With Alkaline Pleural Effusion

Boerhaave Syndrome With Alkaline Pleural Effusion. Kelechi Okoli, MD; Vamsee Marina, MD; Hussam Elkambergy, MD; Geetali Mohan, MD; Veejay Mahajan, MD. OHIO THORACIC SOCIETY 57 TH ANNUAL CONFERENCE 7 - 8 SEPTEMBER, 2007. Pleural Fluid pH in Esophageal Rupture. Gastric acid reflux 1 ?

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Boerhaave Syndrome With Alkaline Pleural Effusion

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  1. Boerhaave Syndrome With Alkaline Pleural Effusion Kelechi Okoli, MD; Vamsee Marina, MD; Hussam Elkambergy, MD; Geetali Mohan, MD; Veejay Mahajan, MD OHIO THORACIC SOCIETY 57TH ANNUAL CONFERENCE 7 - 8 SEPTEMBER, 2007

  2. Pleural Fluid pH in Esophageal Rupture • Gastric acid reflux1? • Bacterial metabolism? • Neutrophil metabolism2? • Only elimination of neutrophils prevented fall in pH in experimental esophageal rupture • Abbott OA, Mansour KA, Logan WD, etal: Atraumatic so-called "spontaneous" rupture ofthe esophagus. J Thorac Cardiovasc Surg 59:6742, 1970 • Good JT Jr, Antony VB, Reller LB, Maulitz RM, Sahn SA. The pathogenesis of the low pleural fluid pH in esophageal rupture. Am Rev Respir Dis. 1983 Jun;127(6):702-4

  3. HPI • 41 year-old type 1 diabetic • Two days of nausea and vomiting • PMH: ESRD, CVA, PE • Uremia. Hyperkalemia. DKA • Hemodialysis and insulin • Resolution of clinical and biochemical abnormalities

  4. HPI • On fifth hospital day, he vomited • Acute dyspnea • BP 89/30mmHg; HR 128/min; RR 34/min; SaO2 83%; Temp 36.6oC • Absent breath sounds over left hemithorax • Portable CXR obtained

  5. Intervention • Left tube thoracostomy • Left lung re-expansion • Persistent air leak • Non-ionic contrast esophagogram

  6. Pleural Fluid • pH – 7.51 • LDH – 184 IU/L • Protein – 2.8 g/dL • Amylase – 2400 U/L • No WBC seen • Oral flora, Klebsiella, Haemophilus Blood . pH – 7.28 . LDH – 196 IU/L . Protein – 3.9 g/dL . WBC – 17.8 x 109 1. Corning pH meter

  7. Outcome • Left thoracotomy and decortication • 2cm perforation in left posterolateral esophageal wall 3cm proximal to EGJ • Complicated post-operative course • Ventilator dependent • Expired in palliative medicine unit

  8. Conclusion • Current case supports neutrophil metabolism • Temporal relationship between symptom onset and pleural fluid sampling should be considered when esophageal rupture is suspected

  9. Abstract

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