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Epigastric pain: a life-threatening condition
  1. Ashish Chawla,
  2. Pratik Mukherjee,
  3. Dinesh Singh
  1. Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
  1. Correspondence to Dr Ashish Chawla, Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; ashchawla{at}

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Clinical introduction

An 82-year-old woman presented to the ED with complaint of severe epigastric pain since last 2 days. The pain was progressive in severity and associated with vomiting. Physical examination revealed mild epigastric tenderness and bibasilar crepitations while the ECG was unremarkable. Laboratory tests were within normal range. A frontal chest radiograph was obtained (figure 1).

Figure 1

Frontal chest radiograph.


  • Which organ is the most probable cause of epigastric pain, based on the radiographic findings?

    1. Lung and pleura

    2. Ribs

    3. Thymus

    4. Stomach

Answer D

The frontal chest radiograph (figure 2) shows a large opacity in the retrocardiac region with an air–fluid level. The borders of the opacity extend beyond the cardiac shadow. These findings are suggestive of herniation …

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  • Contributors PM and AC prepared the manuscript, carried out the literature search, revised the manuscript and are guarantors for the report. PM had the original idea and revised the manuscript. DS edited the manuscript and provided the images.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.