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A man aged 48 years with untreated hypertension presented with sudden onset severe tearing epigastric pain and nausea with no radiation. He denied fever, vomiting, diarrhoea, tea-coloured urine, peptic ulcer disease or non-steroidal anti-inflammatory drugs use. He was afebrile but appeared distressed, with BP 164/109 mm Hg, HR 71 bpm and oxygen saturation 100% on room air. Abdomen was non-tender and bowel sounds active. Respiratory and cardiovascular examination was unremarkable. ECG, CXR and abdominal X-ray, urinalysis and blood tests were normal. He received parental hyoscine and tramadol without relief. Bedside ultrasound was performed (figure 1) (online supplemental video 1).
What is the diagnosis?
Contributors All authors contributed equally to the writing process.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
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