A 66-YEAR-OLD retired executive experienced sudden onset of severe interscapular pain after forceful vomiting. His medical history was notable for peptic ulcer disease and hiatal hernia, but he denied alcohol abuse. Remarkable findings on physical examination included decreased breath sounds and rales on the right side of his chest. Vital signs were blood pressure, 170/90 mm Hg; respiratory rate, 32 breaths per minute; heart rate, 116 beats per minute; and temperature, 36.8°C. Radiographs were obtained (Figure 1 and Figure 2).