每日一题_2025.06.20

A previously healthy 59-year-old man presented to the emergency department with a 5-hour history of severe, pleuritic chest pain. Half an hour before the onset of symptoms, he vomited a large amount of gastric contents after eating street food. On physical examination, his breathing was found to be rapid and shallow. Palpable crepitus was noted in the neck, and breath sounds at the base of the right lung were diminished. Computed tomography of the chest is shown here. What is the most likely diagnosis?

一名既往体健的59岁男性因持续5小时的严重胸膜性胸痛急诊就诊。症状发作前半小时，他在食用街边食物后大量呕吐胃内容物。体格检查发现其呼吸急促表浅，颈部可触及握雪感（皮下捻发音），右肺底部呼吸音减弱。胸部CT影像如图所示。最可能的诊断是？

A. Aortoesophageal fistula主动脉食管瘘

B. Aspiration pneumonitis吸入性肺炎

C. Esophageal rupture食管破裂

D. Perforated Peptic Ulcer消化性溃疡穿孔

E. Tension Pneumothorax with subcutaneous emphysema张力性气胸伴皮下气肿

答案解析：

胸部CT显示纵隔积气向上延伸至颈部、食管穿孔、右侧胸腔积液及右肺不张。经水溶性造影剂吞咽检查（食管造影）证实存在食管大面积撕裂伤，并可见造影剂外渗至纵隔。最终确诊为Boerhaave综合征——一种因剧烈呕吐或干呕导致的危及生命的自发性食管破裂。

正确答案：C