Chest pain is a common cause of hospitalization. Occasionally, chest pain is due to spontaneous perforation of the oesophagus, a dangerous condition that is often misdiagnosed. This case illustrates different aspects of Boerhaave's syndrome. In patients with chest pain of uncertain etiology, chest radiographs or CT scan of the thorax should be performed. If pneumo-(hydro) thorax and/or mediastinal air is observed, oesophageal contrast studies must be carried out to verify perforation of the oesophagus. The preferred treatment is immediate operation and closure of the defect.
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