Editor,—Drs Onyeka and Booth present an interesting case of tension pneumothorax associated with Boerhaave's syndrome.¹ I have previously described a similar case in a 47 year old man who survived his ordeal in 1996.² As the authors note, awareness of the condition is the mainstay of diagnosis.

Aside from these two cases, tension pneumothorax has been described in association with rupture of a Barrett's oesophagus³ and after rupture of an oesophageal diverticulum.⁴ It is worth noting that by far the commonest cause of oesophageal rupture is after endoscopy. Regardless of the cause of rupture I agree with the authors that a gastrograffin oesophogram is the diagnostic procedure of choice.

Conservative management of oesophageal rupture is now a well established option in iatrogenic rupture and has been described in Boerhaave's syndrome,^{5, 6} although as the authors note, immediate surgery comprising drainage and repair is the mainstay of curative treatment.