Correct!
2. Esophageal rupture
The information regarding a recent upper gastrointestinal illness leading to severe bouts of vomiting with retching, followed by chest pain, specifically suggests the possibility of esophageal rupture. Thoracic spine discitis would be expected to cause back pain, possibly with fever, typically in the context of an infectious source elsewhere that leads to bacteremia seeding of the bloodstream. Occasionally discitis and spinal osteomyelitis could be caused by more indolent infections, such as Mycobacterium tuberculosis or endemic fungi, but the patient’s pain would still more likely be posteriorly located, not epigastric and substernal in location. The pain associated with symptomatic pneumothorax would more likely be lateralizing and accompanied by shortness of breath, and the pneumothorax would likely have been visualized at frontal chest radiography. Similarly, chest discomfort associated with empyema would also more likely lateralize, and the pleural abnormality associated with this condition should be visible at chest radiography. Torsion of a lobe of the lung is an exceedingly rare condition that typically occurs following thoracic surgery and lobectomy, which is not a relevant consideration for this patient. Furthermore, chest radiographs are typically abnormal in patients with pulmonary torsion, showing areas of consolidation. Such findings are non-specific, but are nevertheless entirely lacking on this patient’s frontal chest radiograph.).
Given the above information, which of the following represents the most appropriate next step for the management of this patient? (Click on the correct answer to proceed to the seventh of nine pages)