Having experienced two cases of Boerhaave's syndrome (spontaneous rupture of the oesophagus), one a 42-year-old man, the other a 76-year-old woman, who both died of complications failing operative repair, the authors undertook a survey of the literature in order to evaluate the role of radiology in the detection of this life-threatening condition. An analysis of 118 clinically and 67 radiologically well-documented cases yielded pathologic findings in chest X-rays in 90% of the cases. Hydropneumothorax was found in 51%, pneumomediastinum in 30%, isolated pleural effusion in 25%, and infiltration of the parenchyma in 14% of the patients. In all cases it was possible to demonstrate by contrast medium-filling of the oesophagus with an aqueous medium.