Mallory-Weiss tear vs Boerhaave syndrome
How to tell Mallory-Weiss tear and Boerhaave syndrome apart when a board question makes them look alike.
Mallory-Weiss is mucosal bleeding; Boerhaave is transmural rupture with mediastinal air or toxicity.
Side by side
Upper GI bleeding after retching from a mucosal tear at the gastroesophageal junction, usually without mediastinitis.
Severe chest pain, dyspnea, fever, subcutaneous emphysema, or mediastinal air after vomiting from transmural esophageal rupture.
Forceful retching lacerates mucosa and submucosa without full-thickness esophageal wall disruption.
Sudden pressure rise tears the full esophageal wall, leaking contents into the mediastinum.
Hematemesis after vomiting with linear mucosal tear on endoscopy supports Mallory-Weiss tear.
Pneumomediastinum, pleural effusion, contrast leak, fever, or shock supports Boerhaave syndrome.
The trap
Both follow violent retching or vomiting (alcoholic binge, bulimia, hyperemesis), so the trigger overlaps completely. The deciding finding is the layer involved and the chest signs. Mallory-Weiss is a longitudinal MUCOSAL tear at the gastroesophageal junction, presenting with hematemesis that is usually self-limited; treatment is supportive plus endoscopy if bleeding persists or is severe. Boerhaave is a TRANSMURAL esophageal rupture (full-thickness) with mediastinitis, severe chest or abdominal pain, subcutaneous emphysema (palpable crepitus in the neck), Hamman crunch (crackling synchronous with the heartbeat), and mediastinal air or pleural effusion on chest X-ray or CT; this is a surgical emergency with high mortality if treatment is delayed beyond 24 hours.
Watch it explained
Test it nowThe repair move
After retching, ask whether the key finding is blood from mucosa or air/sepsis from full-thickness rupture.
Try a free question
CoreA patient has repeated forceful vomiting followed by hematemesis. He is stable, and endoscopy shows a linear mucosal tear at the gastroesophageal junction. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Mallory-Weiss tear. Mallory-Weiss tear is a mucosal laceration after retching that causes upper GI bleeding without transmural rupture.
Why the other choices are tempting
- B. Boerhaave syndrome is transmural rupture with severe chest pain, mediastinal air, and toxicity.
- C. Varices cause hematemesis but require portal hypertension clues.
- D. Perforated ulcer causes sudden peritonitis and free air under the diaphragm.
- E. Adenocarcinoma causes progressive dysphagia and weight loss, not acute post-retch bleeding.
Flashcards
Tap a card to flip it.
What injury depth defines Mallory-Weiss tear?
It is a mucosal or submucosal laceration, usually near the gastroesophageal junction.
What injury depth defines Boerhaave syndrome?
It is a transmural esophageal rupture that can leak air and contents into the mediastinum.
Quick answers
What is the fastest way to tell Mallory-Weiss tear from Boerhaave syndrome?
Mallory-Weiss is mucosal bleeding; Boerhaave is transmural rupture with mediastinal air or toxicity.
What is the key clue for Mallory-Weiss tear?
Upper GI bleeding after retching from a mucosal tear at the gastroesophageal junction, usually without mediastinitis.
What is the key clue for Boerhaave syndrome?
Severe chest pain, dyspnea, fever, subcutaneous emphysema, or mediastinal air after vomiting from transmural esophageal rupture.
What is the common trap with Mallory-Weiss tear vs Boerhaave syndrome?
Both follow violent retching or vomiting (alcoholic binge, bulimia, hyperemesis), so the trigger overlaps completely. The deciding finding is the layer involved and the chest signs. Mallory-Weiss is a longitudinal MUCOSAL tear at the gastroesophageal junction, presenting with hematemesis that is usually self-limited; treatment is supportive plus endoscopy if bleeding persists or is severe. Boerhaave is a TRANSMURAL esophageal rupture (full-thickness) with mediastinitis, severe chest or abdominal pain, subcutaneous emphysema (palpable crepitus in the neck), Hamman crunch (crackling synchronous with the heartbeat), and mediastinal air or pleural effusion on chest X-ray or CT; this is a surgical emergency with high mortality if treatment is delayed beyond 24 hours.