Milk in the intercostal tube: Revealing Boerhaave syndrome

We present an uncommon pathology of Boerhaave's syndrome and its fatal outcome in a 77-year-old man who presented to the emergency room with loss of consciousness and a history of chronic cough that had increased in intensity over the past week. Radiological investigations revealed bilateral pleural effusion, initially pointing to a transudative aetiology. Diagnostic pleural aspiration showed an exudative effusion with high amylase, and an intercostal drainage tube was inserted for the left massive effusion. Contrary to the initial provisional diagnosis, the discovery of ingested milk in the intercostal drainage tube raised suspicion of Boerhaave's syndrome. Around 90% of perforations occur on the left side of the distal oesophagus, presenting as a pleural effusion on the left side. Less than 10% of patients experience bilateral pleural effusions. This patient's clinical presentation, which led to the diagnosis, is of interest. Unfortunately, he eventually lapsed into sepsis and succumbed.