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Patients also present with varying degrees of epigastric tenderness, sometimes imitating an intra abdominal catastrophe. Plain chest radiographs may show mediastinal or free peritoneal air (most common finding on initial films), a widened mediastinum, hyrdrothorax, hydropneumothorax, or mediastinal emphysema. Ten to fifteen percent of all patients presenting with Boerhaave's Syndrome may have a normal plain chest radiograph.A swallow contrast radiographic study remains the diagnostic gold standard.

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