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On August 10, 2017, at 9:30 am, the emergency team delivered the patient M. with a diagnosis of ACS in the SRI KKB #1 n.u. professor Ochapovsk?. At admission, he complained of intense pain behind the breastbone, a pressing, compressive nature, intensifying with breathing, extending into the interlopar and lumbar regions, intensifying with deep inspiration, diminishing in the position on the diseased side, a feeling of lack of air. On examination: complaints of pain of moderate intensity in the same areas of the chest with irradiation into the interlopacal and lumbar regions, accompanied by a feeling of lack of air, attracted attention to the patient’s forced position on the left side, paleness and moisture of the skin, frequent shallow breathing. Cardiac tones are clear, rhythmic, heart rate - 106 per minute. The arterial pressure is 110 and 70 mm Hg. When palpating the abdomen is painless. ECG: sinus tachycardia, an increase in the amplitude of the T wave. ECHO: EDD 40mm, EF> 55% normal local contractility, RV 25 mm. Laboratory: leukocytosis (25.30 10e9 / l) with neutrophilia, cardiac troponin was normal. Chest X-ray within the age limit. CT of the chest, abdominal and aortic: in the mediastinum, from the level of the upper aperture to the diaphragm, along the course of the main vessels, esophagus and bronchi, an extensive accumulation of air. ? detailed search revealed a defect in the left wall of the distal part of esophagus up to 2.7 mm, which communicates the lumen of the esophagus and the paraeophageal space (Fig. 1). On 10.08.17 at 11:30 a.m. the patient was diagnosed: Boerhaave’s syndrome. The patient was transported to the surgical department SRI KKB #1 n.u. professor Ochapovsky. It was made easophagorrhaphy and he was discharged 13 days later. So, a rare disease with a prevalence of 1: 10,000 was diagnosed in just 2 hours and the patient was rescued.
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