Snapshot A 19-year-old woman presents to the emergency department with severe retrosternal chest pain. Her symptoms began immediately after vomiting. Medical history is significant for bulimia nervosa. Physical examination is notable for crepitus upon chest wall palpation. A barium swallow study is shown. Introduction Clinical definition login to view 2 more bullets Epidemiology login to view 3 more bullets Pathogenesis login to view 8 more bullets Prognosis login to view 3 more bullets Presentation Symptoms login to view 1 more bullet 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 Diagnostic criteria login to view 1 more bullet Differential Mallory-Weiss syndrome login to view 1 more bullet Myocardial infarction Pancreatitis Peptic ulcer perforation Aortic aneurysm dissection Spontaneous pneumothorax Treatment Conservative login to view 3 more bullets Operative login to view 3 more bullets Complications Sepsis Pneumomediastinum Mediastinitis Empyema Subcutaneous emphysema Mediastinal abscess