A 19-Year-Old College Student Is Brought to the Emergency Department

A 19-year-old college student is brought to the emergency department by his friends due to severe retrosternal and upper abdominal pain.  The patient was out with his friends drinking alcohol and celebrating the end of final exam week.  An hour before arrival, he had several episodes of emesis, which is when he began experiencing the pain.  He has had no medical issues other than ankle sprains while playing basketball.  The patient has smoked cigarettes on several occasions and drinks alcohol on the weekends.  His father died of a myocardial infarction at the age of 45.  Temperature is 38.3 C (101 F) , blood pressure is 95/56 mm Hg, pulse is 120/min, and respirations are 30/min.  Pulse oximetry is 97% on room air.  Height is 201 cm (6 ft 7 in) , and weight is 90 kg (198.4 lb) .  On physical examination, the patient appears intoxicated and diaphoretic.  Oral mucous membranes are dry, and there is no pharyngeal erythema.  Cervical lymph nodes are not enlarged, but there is palpable crepitus in the suprasternal notch.  Lung auscultation reveals bilateral symmetric breath sounds.  Heart sounds are normal.  There is mild epigastric tenderness without guarding or rebound.  There is no extremity edema or cyanosis.  Which of the following is the most likely cause of this patient's current condition?

A) Alcohol-induced pancreatitis
B) Aortic dissection
C) Aspiration pneumonitis
D) Esophageal perforation
E) Mallory-Weiss syndrome
F) Ruptured subpleural bleb

Correct Answer:

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