Abstract

Boerhaave syndrome (BS) is a rare, life-threatening condition characterized by spontaneous esophageal rupture, commonly triggered by forceful vomiting. Due to its nonspecific presentation, BS is often misdiagnosed, leading to delayed intervention and high mortality. We report a case of BS presenting with hematemesis, respiratory distress, and collapse, emphasizing the forensic implications and the role of postmortem computed tomography (PMCT) in virtual autopsy. A 46-year-old male with a history of alcohol consumption experienced sudden-onset hematemesis and respiratory distress, followed by cardiopulmonary arrest. Despite resuscitation efforts, the patient was pronounced dead. Autopsy findings revealed a full-thickness esophageal rupture with mediastinal contamination and pleural effusions, confirming BS as the cause of death. PMCT successfully detected pneumomediastinum, free intrathoracic air, and mediastinal fluid, demonstrating its utility in forensic investigations. The case highlights key differential diagnoses of sudden death, including acute myocardial infarction, pulmonary embolism, and aortic dissection. This case aligns with existing literature where hematemesis, though less commonly reported, was a significant symptom preceding cardiovascular collapse. Delayed diagnosis of BS remains a critical factor contributing to poor outcomes and increased mortality rates. The integration of PMCT with conventional autopsy enhances the diagnostic accuracy of esophageal perforation-related deaths, particularly in forensic settings. Comparative analysis with previously reported cases underscores the need for heightened clinical suspicion and early imaging to prevent fatal outcomes. Boerhaave syndrome remains a diagnostic and therapeutic challenge, often leading to sudden and unexpected death. This case reinforces the medicolegal importance of virtual autopsy in identifying esophageal rupture, particularly in unwitnessed or unexplained deaths.

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