A 66-YEAR-OLD retired executive experienced sudden onset of severe interscapular pain after forceful vomiting. His medical history was notable for peptic ulcer disease and hiatal hernia, but he denied alcohol abuse. Remarkable findings on physical examination included decreased breath sounds and rales on the right side of his chest. Vital signs were blood pressure, 170/90 mm Hg; respiratory rate, 32 breaths per minute; heart rate, 116 beats per minute; and temperature, 36.8°C. Radiographs were obtained (Figure 1 and Figure 2).
A. Malory-Weiss tear
B. Spontaneous rupture of the esophagus
C. Perforated duodenal ulcer
D. Severe gastritis
Corresponding author and reprints: Grace S. Rozycki, MD, Department of Surgery, Emory University, Glenn Memorial Building, Room 302, 69 Butler St SE, Atlanta, GA 30303 (e-mail: firstname.lastname@example.org).
Rozycki GS. Image of the Month. Arch Surg. 2001;136(3):355-356. doi: