As a life-threatening problem, esophageal perforation should be diagnosed and treated rapidly to provide a good outcome for the patient and prevent serious adverse sequelae. In 1724, Hermann Boerhaave described the syndrome after observing, on postmortem examination, a transmural rupture of the distal esophagus in Admiral Baron John de Wassenaeur of the Holland Navy.1- 2 Although gastroesophageal reflux is often associated with the syndrome, other entities, including neurological diseases, hypertension, alcoholism, peptic ulcer disease, esophageal stricture, esophagitis, or neoplasm, are contributory factors. Presenting symptoms are often vomiting, nausea, and sharp chest pain. Patients are frequently dyspneic and, in an effort to minimize discomfort, sit upright and forward. Pertinent physical findings include basilar rales, wheezing, and crepitus along the chest wall.