Boerhaave Syndrome has a higher incidence in the male gender, at an average of 50 years of age.11 Its predisposing factors would be alcoholism, a neurological disease, a peptic ulcer, a hiatal hernia or arterial hypertension.12 However, many sick individuals do not present any of these disorders. The classic clinical triad includes: vomiting, pain in the chest and subcutaneous emphysema.13
Necrotising faciitis in a diabetic foot: There is extensive subcutaneous emphysema tracking along the facial planes throughout the foot and distal leg. Note that the proximal extent of the subcutaneous gas is not visualized.
The Mackler triad is a term that defines the classical presentation seen in Boerhaave syndrome. It comprises: 1. Vomiting 2. Lower chest pain 3. Subcutaneous emphysema Subcutaneous emphysema is only seen in approximately half of patients at the initial presentation (typically in those patients who present later)