What confirmatory test is used in the diagnosis of Boerhaave's syndrome?

The confirmatory test used in the diagnosis of Boerhaave's syndrome is a water-soluble contrast esophagram. Boerhaave's syndrome is characterized by a spontaneous rupture of the esophagus due to severe vomiting or other causes of increased intrathoracic pressure.

The water-soluble contrast esophagram is particularly useful because it allows for visualization of leaks in the esophageal wall. If there is a rupture, the contrast material will extravasate into the mediastinum or pleural space, which can be identified on imaging. This test is preferred because it is less likely to cause irritation or complications than barium contrast, which can worsen mediastinal contamination in case of a rupture.

While other imaging modalities can provide valuable information regarding the esophagus and surrounding structures, they do not specifically confirm the presence of a rupture. For example, a chest ultrasound might help identify fluid collections but would not visualize the esophagus directly. A CT scan of the abdomen can also be useful in detecting leaks or mediastinal air, but it is not as definitive as a water-soluble esophagram for establishing the diagnosis of Boerhaave’s syndrome. Esophageal manometry primarily assesses esophageal motility and would not be helpful in diagnosing a