RT Journal
A1 Osborn HA, Papsin BC
T1 ACute onset of retrosternal and epigastric pain
JF JAMA
JO JAMA
YR 2013
FD February 27
VO 309
IS 8
SP 823
OP 824
DO 10.1001/jama.2013.737
UL http://dx.doi.org/10.1001/jama.2013.737
AB 
A 15-year-old previously healthy male presents to the emergency department with acute onset of severe pleuritic retrosternal and epigastric pain after swallowing a mouthful of cold soda. He has no previous surgeries or major illnesses, no history of trauma, and no recent emesis. Following the onset of pain he waited several hours and ate 4 chili dogs before presenting to the emergency department. Findings from a general physical examination revealed a healthy, well-appearing young man with mild epigastric tenderness but an otherwise benign abdomen and stable vital signs. A lateral chest radiograph (Figure, A) revealed a small amount of pneumomediastinum, and a soft tissue lateral neck radiograph revealed retropharyngeal and paratracheal air. Radiography was followed by performance of a computed tomography scan in the emergency department (Figure, B).