Keep esophageal rupture on your differential for deadly causes of chest, epigastric or back pain. We don’t see it often, but it’s a real thing.

Boerhaave Syndrome is the spontaneous rupture of the esophagus that is caused by a sudden increase in intraesophageal pressure, as seen in forceful vomiting. So, if the patient presents with the right symptoms and any vomiting in their history, keep this diagnosis in mind. Other causes you might see, though less common, are childbirth, seizure, prolonged coughing or laughing, or weightlifting.