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). ### Supplementary video [emermed-2021-212147supp001.mov] Figure 1 Axial and longitudinal view of ultrasound abdomen. What is the diagnosis? 1. Acute …

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一名 48 岁男性突发严重的上腹痛

一名未治疗高血压的 48 岁男性突然出现严重的撕裂性上腹痛和恶心，但未接受放射治疗。他否认发烧、呕吐、腹泻、茶色尿液、消化性溃疡病或使用非甾体抗炎药。他没有发热，但看起来很痛苦，BP 164/109 mm Hg，HR 71 bpm，室内空气氧饱和度 100%。腹部无压痛，肠鸣音活跃。呼吸和心血管检查无异常。心电图、CXR 和腹部 X 光片、尿液分析和血液检查均正常。他接受了父母的hyoscine和曲马多而没有缓解。进行了床边超声检查（图 1）（在线补充视频 1）。### 补充视频 [emermed-2021-212147supp001.mov] 图 1 超声腹部的轴向和纵向视图。诊断结果是什么？1. 急性…