A 50-year-old patient develops sudden left lower chest pain and epigastric pain after vomiting. The patient shows diaphoresis, breath sounds are decreased on the left, and there is abdominal guarding. The most appropriate diagnostic test is:

D. Film of the chest

DISCUSSION: The history of pain after vomiting efforts suggests esophageal rupture. Pain is often described as excruciating and frequently masquerades as a dissecting aneurysm, perforated ulcer, or myocardial infarction. Decreased breath sounds suggest the possibility of hydropneumothorax. The diagnostic procedure is a chest film. More than 90% of patients with an esophageal perforation show abnormalities suggestive of perforation. The findings are influenced by the interval between perforation and the examination, by the site of the perforation, and by the integrity of the mediastinal pleura. Esophagoscopy is not indicated.