Image of the Week: A drinking binge leads to a surgical emergency

A 58-year-old man presents to the emergency department with dyspnea and with severe chest pain that radiates to his shoulder. He has a history of alcoholism and has just finished a 4-day drinking binge. On examination, crepitus is heard on palpation of the chest wall, and his pain worsens as he swallows. A diagnosis of Boerhaave syndrome is suspected, and ...