Esophageal rupture may occur from an external force such as an explosion or trauma to the chest, spontaneously as from vomiting, by instrumental peforations during endoscopy, or by foreign bodies. A case of Boerhaave syndrome was seen in a healthy 52 years old man who complained of substernal pain, vomiting and dyspnea after over-drinking. Abnormalities seen on the chest film were: A) hydropneumothorax B) mediastinal emphysema and C) subcutaneous emphysema. These characteristic roentgen findings were confirmed an esophageal rupture.