Severe and/or prolonged vomiting may rarely be accompanied by lesions of the lower esophagus. If a mucosal tear with hemorrhage occurs, this is called Mallory Weiss syndrome. If the esophagus ruptures, this is known as Boerhaave syndrome. Seen here posteriorly is the upper esophagus and the lower esophagus with a probe at the site of rupture. After several days, purulent exudate is present over the right lung pleura (an empyema). Both of these syndromes have a high morbidity and mortality.