The “v sign” in the diagnosis of spontaneous rupture of the esophagus (an early roentgen clue)

Naclerio, Emil A.

doi:10.1016/0002-9610(57)90781-x

Cited by 118 publications

(32 citation statements)

References 7 publications

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“…3,19 The V sign of Nacleiro, being radiolucent streaks of air passing along the aorta and diaphragm, may also be present. 20 None of these features were seen on the chest X-rays of the patients in the current series. Similar to many reports, we used contrast swallows, with both water-soluble contrast and subsequent dilute barium, to exclude esophageal perforation; however, false negative results have been obtained in 27%-66% of patients with esophageal perforation.…”

Section: Discussionmentioning

confidence: 72%

Vomiting-Induced Pneumomediastinum and Subcutaneous Emphysema Does Not Always Indicate Boerhaave's Syndrome: Report of Six Cases

et al. 2007

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Spontaneous pneumomediastinum is an uncommon, self-limiting condition resulting from alveolar rupture in young adults. Because of the ambiguous presentation and the general lack of awareness of this condition, its diagnosis is often delayed, missed, or confused with spontaneous esophageal perforation. We report our experience of treating six patients who were referred to our unit with vomiting-induced pneumomediastinum, subcutaneous emphysema, and an initial diagnosis of spontaneous esophageal perforation. Ultimately, we diagnosed spontaneous pneumomediastinum in all six patients, who recovered uneventfully without any surgical intervention. We review the literature with particular emphasis on differentiating spontaneous pneumomediastinum from spontaneous esophageal perforation.

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Section: Discussionmentioning

confidence: 72%

Vomiting-Induced Pneumomediastinum and Subcutaneous Emphysema Does Not Always Indicate Boerhaave's Syndrome: Report of Six Cases

et al. 2007

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“…The air escaping from the esophagus accumulates in a V form in the left lower mediastinum along the aorta and above the left diaphragm [15].…”

Section: Discussionmentioning

confidence: 99%

Treatment of endoscopic esophageal perforation

et al. 1999

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“…One may note air tracking along the left lower mediastinal border and along the left hemidiaphragm, this is often referred to as the "v sign" or the "Naclerio v sign" after the physician who initially reported it in 1957. [1] Contrast esophagography with a water-based contrast medium remains the definitive imaging modality of choice, identifying about 90% of intra-thoracic esophageal perforations. However, given its widespread use and ease of access, computed axial tomography has become the initial imaging modality as it assesses the degree of the esophageal tear as well as closely examines the potential associated complications and surrounding structures.…”

Section: Discussionmentioning

confidence: 99%

When gastroenteritis isn't: a case report of a 20-year-old male with Boerhaave's syndrome complicated by intra-abdomimal hemorrhage

Baird¹,

Norinsky²

2016

World Journal of Emergency Medicine

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Here we present the case of a 20-year-old male with a known history of an artificial mechanical aortic valve replacement at ages four and twelve, on chronic warfarin therapy, who presented to our community emergency department for the evaluation of vomiting, diarrhea, generalized malaise and abdominal pain. He was seen at a local urgent care for similar symptoms earlier in the day, subsequently discharged with a diagnosis of mild gastroenteritis; however, according to the patient's sister, upon his return home he looked very unwell and she called an ambulance immediately. He stated the vomiting was nonbloody, nonbilious and without a coffee-ground appearance; the diarrhea likewise was nonbloody, nonmelenic, but mucousy. He had chills, but denies recent fevers, urinary complaints, back pain, chest pain, cough, or dyspnea. No recent illnesses, sick contacts, or travel. The patient denied any other medical or surgical history. Importantly, the patient reported no recent adjustments in his warfarin dose, admitted compliance, with last INR 2.1 two days prior to presentation.He was immediately brought to an examination room for evaluation (ESI level 1) and upon initial presentation was found to be toxic-appearing. Initial vital signs were as follows: blood pressure 88/52 mmHg, pulse rate 138 beats/minute, breathing 32 respirations/minute, a rectal temperature of 94.2 degrees Fahrenheit, and saturating 91% on ambient air. He was ashen, with sunken eyes and dry mucous membranes. Conjunctivae were pale. Cardiopulmonary exam was significant for tachypnea, tachycardia, and a systolic murmur consistent with his history of aortic valve replacement. Abdomen was soft, nondistended, diffusely tender without particular focal tenderness in any quadrant, and hypoactive bowel sounds, without peritoneal signs of guarding, rebound, or rigidity. Rectal examination revealed no gross or microscopic blood. Peripheral pulses were weak but palpable in the radial and femoral arteries. The remaining physical examination was unremarkable.Given his significant presentation and past medical history, an extensive work-up was immediately undertaken specifically focusing on inflammatory markers, bleeding studies, and imaging of the abdomen. The patient was mentating, had no signs of impending airway or breathing decompensation. Nursing staff was instructed to place two large-bore intravenous lines, with two boluses of warmed normal saline and to cover the patient with a Bair hugger. An emergent bedside ultrasound of the abdomen via RUSH protocol (rapid ultrasound for shock/hypotension) was performed by the emergency physicians, revealing a moderateto-large amount of intra-abdominal free fluid in the splenorenal, hepatorenal, and perivesicular spaces; the inferior vena cava was fully collapsed; the left ventricle was hyperdynamic; there was no evidence of pericardial effusion, abdominal aortic aneurysm or dissection. A bedside chest radiograph revealed no evidence of infi ltrates or pleural effusions, subdiaphragmatic free air, pneumothorax, or any...

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The “v sign” in the diagnosis of spontaneous rupture of the esophagus (an early roentgen clue)

Cited by 118 publications

References 7 publications

Vomiting-Induced Pneumomediastinum and Subcutaneous Emphysema Does Not Always Indicate Boerhaave's Syndrome: Report of Six Cases

Vomiting-Induced Pneumomediastinum and Subcutaneous Emphysema Does Not Always Indicate Boerhaave's Syndrome: Report of Six Cases

Treatment of endoscopic esophageal perforation

When gastroenteritis isn't: a case report of a 20-year-old male with Boerhaave's syndrome complicated by intra-abdomimal hemorrhage

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