Snapshot A 19-year-old college student presents to the emergency department with excruciating retrosternal chest pain that radiates to the back. She describes the pain as sharp and worsens with swallowing. She reports that her symptoms began after vomiting 1 hour ago. Medical history is significant for anorexia nervosa. Her temperature is 100.4°F (38°C), blood pressure is 135/90 mmHg, pulse is 105/min, and respirations are 20/min. On physical exam, there is crepitus upon chest palpation. A barium esophagram is performed and shows leakage of water-soluble contrast from the lower thoracic esophagus. Introduction Clinical definition login to view 2 more bullets Epidemiology Associated conditions login to view 2 more bullets ETIOLOGY Pathogenesis login to view 9 more bullets Presentation Symptoms login to view 3 more bullets Physical exam login to view 4 more bullets Imaging Contrast esophagram login to view 4 more bullets Computed tomography (CT) scan login to view 2 more bullets Studies Labs login to view 2 more bullets Differential Mallory-Weiss syndrome login to view 1 more bullet Myocardial infarction Pancreatitis Peptic ulcer perforation Aortic aneurysm dissection Spontaneous pneumothorax DIAGNOSIS Diagnostic criteria login to view 1 more bullet Treatment Conservative login to view 3 more bullets Operative login to view 3 more bullets Complications Sepsis Pneumomediastinum Mediastinitis Empyema Subcutaneous emphysema Mediastinal abscess Prognosis Associated with high morbidity and mortality login to view 2 more bullets