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Upper Abdominal Pain, No Relief from Pepto-Bismol: Seen in the ED
A man in his mid-sixties reports constant bilateral chest pain that radiates to the back that began yesterday. Can you Dx based on the CT image here?
Brady Pregerson, MD
History of present illness. A man in his mid-sixties with a history of endoscopy-confirmed gastroesophageal reflux disease (GERD) and esophagitis presents to the emergency department with epigastric/chest pain. He reports constant bilateral chest pain radiating to the back since the day before. He denies any aggravating factors, shortness of breath, nausea, or vomiting. He took Pepto-Bismol with minimal relief.
Vital signs & physical examination. Vital signs are normal except for elevated blood pressure (190/115 mm Hg). Other than mild epigastric tenderness, the physical examination is otherwise unremarkable.
Initial diagnostic testing
CBC: normal
CRP: 2.4
Blood chemistry: bilirubin 1.3/0.4 mg/dL, ALT/AST 120/60 U/L
Imaging: see CT below
What is the most likely diagnosis?
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