Diagnostic Resilience in the Emergency Department: Boerhaave Syndrome Masquerading as Acute Coronary Syndrome and the Critical Utility of Point-of-Care Ultrasound

Parvathy Vivek, Ajith Kumar

Abstract: Boerhaave syndrome is a rare but life-threatening spontaneous esophageal rupture that often mimics more common thoracic emergencies. We present the case of a 46-year-old male referred to the emergency department (ED) with a preliminary diagnosis of acute coronary syndrome (ACS). Despite electrocardiographic findings of J-point elevation, bedside physical examination and point- of-care ultrasound (POCUS) identified a massive complex pleural effusion. Advanced imaging confirmed a distal esophageal perforation, and surgical intervention yielded 2 liters of pathognomonic black-colored fluid containing vegetable matter. This article explores the pathophysiology of barogenic injury, the pitfalls of diagnostic anchoring, and the critical role of POCUS in resolving diagnostic uncertainty to ensure timely multidisciplinary intervention.

Keywords: Boerhaave Syndrome, Point-of-Care Ultrasound, Esophageal Perforation, Emergency Medicine, STEMI Mimic

How to Cite?: Parvathy Vivek, Ajith Kumar, "Diagnostic Resilience in the Emergency Department: Boerhaave Syndrome Masquerading as Acute Coronary Syndrome and the Critical Utility of Point-of-Care Ultrasound", Volume 14 Issue 12, December 2025, International Journal of Science and Research (IJSR), Pages: 2346-2351, https://www.ijsr.net/getabstract.php?paperid=SR251229211014, DOI: https://dx.doi.org/10.21275/SR251229211014