Background Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure owing to forceful vomiting. Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. We report on two patients of Boerhaave syndrome with different severities that was triggered by excessive alcohol consumption and was diagnosed immediately in the emergency room. Case presentation The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. He was subsequently diagnosed with Boerhaave syndrome coupled with mediastinitis using computed tomography (CT) and esophagogram. An emergency operation was successfully performed, in which a 3-cm tear was found on the left posterior wall of the distal esophagus. The patient subsequently had anastomotic leakage but was discharged 41 days later. The patient in case 2 complained of severe chest pain, nausea, vomiting, and hematemesis on arrival. He was suggested of having Boerhaave syndrome without mediastinitis on CT. The symptoms gradually disappeared after conservative treatment. Upper gastrointestinal endoscopy performed on the ninth day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the patient in case 2 was initially considered to have Mallory–Weiss syndrome. Conclusion Owing to similar histories and symptoms, Boerhaave syndrome and Mallory–Weiss syndrome must be accurately distinguished by emergency clinicians. CT can be a useful modality to detect any severity of Boerhaave syndrome and also offers the possibility to distinguish Boerhaave syndrome from Mallory–Weiss syndrome.

Background Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure derived from forceful vomiting, and subsequent presentation of chest pain, dyspnea, and shock. Case presentation: We present two cases of Boerhaave syndrome that were both triggered by excessive alcohol consumption and quickly detected in the emergency room. The first patient complained of severe chest pain, nausea, and vomited on his arrival: he was diagnosed with Boerhaave syndrome complicated with mediastinitis from the computed tomography (CT) and esophagogram findings. An emergency operation was successfully performed, where a 3-cm tear was found on the left-posterior wall of the distal esophagus. The patient subsequently suffered from anastomotic leakage but was discharged 41 days later. The second patient reported severe chest pain, nausea, vomiting, and hematemesis on his arrival: he was suspected of having Boerhaave syndrome without mediastinitis based on the CT findings. The symptoms gradually disappeared after a conservative treatment. Upper gastrointestinal endoscopy performed on the 9th day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the second patient was also differently diagnosed with Mallory-Weiss syndrome. Conclusion Emergency clinicians must accurately distinguish Boerhaave syndrome from Mallory-Weiss syndrome as they both have similar history and symptoms. CT can be a valuable and useful modality to detect any severity of Boerhaave syndrome.

Background: Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure owing to forceful vomiting. Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. We report on two patients of Boerhaave syndrome with different severities that was triggered by excessive alcohol consumption and was diagnosed immediately in the emergency room.Case presentation: The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. He was subsequently diagnosed with Boerhaave syndrome coupled with mediastinitis using computed tomography (CT) and esophagogram. An emergency operation was successfully performed, in which a 3-cm tear was found on the left-posterior wall of the distal esophagus. The patient subsequently had anastomotic leakage but was discharged 41 days later. The patient in case 2 complained of severe chest pain, nausea, vomiting, and hematemesis on arrival. He was suggested of having Boerhaave syndrome without mediastinitis on CT. The symptoms gradually disappeared after conservative treatment. Upper gastrointestinal endoscopy performed on the ninth day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the patient in case 2 was initially considered to have Mallory–Weiss syndrome.Conclusion: Owing to similar histories and symptoms, Boerhaave syndrome and Mallory–Weiss syndrome must be accurately distinguished by emergency clinicians. CT can be a useful modality to detect any severity of Boerhaave syndrome and also offers the possibility to distinguish Boerhaave syndrome from Mallory–Weiss syndrome.

Many different pulmonary diseases occur in human immunodeficiency virus-infected patients. This was a case of a cavity lesion, although differentiation was extremely difficult pictorially. This was a rare case that led to a definitive diagnosis because the cavity lesions were complicated by pneumothorax, and we could perform a biopsy.

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