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An elderly lady with a complex abdominal surgical history presented with what seemed to be a 2 day history of obstruction - vomiting, distension, and severe abdominal pain. Allowed in these circumstances, see below the AXR. 
What 3 important findings can you see?
5 Comments
Middle aged female presented to the ED Physio clinic 3/52 following onset of left shoulder pain and bruising.
History of Presenting complaint Initial onset of Left upper chest wall atraumatic bruising. At the same time she reported intermittent pain, pins and needles and sensation of pressure, radiating to the hand. A week after the onset of symptoms she noticed a prominence of the veins in over her left upper chest and into her left breast. She presented to the receptionist as ‘Injury to arm/shoulder/tingling sensation’. The RATs Doctor said "?Shoulder dislocation and reduction 2/52 ago. Today left arm pain increased. Vascularly equal upper limbs and x-ray NAD" and referred to the Physio clinic for ‘post reduction pain’. PMH Fibromyalgia, Anxiety. DH Pregabalin, Bisoprolol, Propanolol, Amitriptyline. O/E; Venous engorgement left upper anterior chest wall into left breast. Mild to moderate Supra and infra clavicular swelling left side. Swelling into pectoral border of Left Axilla.Slight increase in left biceps region swelling noted. Pain medial to scapular from C7 to T4 paraspinally. Neuro NAD, Vascular normal. C-spine. Pain in left upper traps on left Rotation and Left Side flexion. No arm symptoms propagated on sustained neck movement. WHAT IS GOING ON? WHAT'S YOUR DIFFERENTIAL? A 34 year old male presented with central crushing pain for 6 hours. Onset was sudden, while cleaning the kitchen. The pain radiated to both arms. He had complained of some chest pain on exertion over the last 3 days, e.g. when climbing stairs. The chest pain did feel better when he sat forward, and worse when lying flat. PMH – he had been treated with omeprazole by the GP for the last 6 weeks for indigestion type symptoms. He was a smoker. On examination – pale, sweaty, in pain, apyrexial, BP 156/90, pulse 80. Heart sounds were normal. He had equal radial pulses. 
What's the diagnosis?
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