Recurrent Boerhaave Syndrome a Rare Cause of Pneumomediastinum

A 48 year old female with history of choledocholithiasis for which she has been admitted several times to the hospital for biliary colics complicated with cholangitis 1 month prior where an Endoscopic retrograde cholangiopancreatography (ERCP) was performed. She presented to the emergency department for ongoing epigastric pain radiating to the back with multiple episodes of vomiting the past week. She also reported chest tightness but no shortness of breath. Initial blood work up showed elevated lipase levels at 1524U/L, white blood cell count at 15x10^3/mm3 and elevated C reactive protein at 237mg/L . The diagnosis of acute pancreatitis was made and CT of the abdomen was performed for severity grading of the pancreatitis along with a chest CT to assess for any cause of chest pain.