32-year-od man comes to the emergency department with intense midline chest pain and diaphoresis of 4 hours duration. Pror to
the onset of pain, he developed nausea and recurrent vomtng after returning rrom a party. His medcal problems include HV
infecton, medication noncomplance, alcohol abuse, and acohol c hepatitis. The patent admits to us ng cocaine regulary. His
temperature is 37.8 C (100 F), blood pressure Is 100/60 mm Hg, pu se is 120/min, and respirations are 28/min. Examination shows
injected conjunctivae and bilateral dilated pupils. Chest x-ray demonstrates a wdened mediasti num and moderate left-sided pleural
effusion. ECG shows s nus tachycardia. Peural fluid is round to be a yellow exudate with high amylase content. Which of the
following s the most likey diagnosis in this patient?
- Q A Acute pancreatitis
- 0 8. Aortc dissection
- 0 C. Aspiration pneumonia
- 0 0. Esophageal perforation
- 0 E. Myocardial infarction
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