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Endocrine Case Report: Coffee Ground Emesis

Our latest case report from Brady Pregerson, MD, features a woman in her late 70s with a history of AF on rivaroxaban brought to the hospital for 12 hours of coffee ground emesis and epigastric pain. Can you determine the correct diagnosis?

History of Present Illness:

A woman in her late 70’s with a history of Afib on Xarelto is brought by ambulance to the hospital for 12 hours of coffee ground emesis and epigastric pain. She denies melena, bleeding, fever, or diarrhea.

Vital Signs & Physical Exam:

Vital signs are normal except for pulse 102

Physical exam is otherwise normal except for epigastric tenderness and occasional mild coffee ground emesis

Initial Diagnostic Testing:

  • CBC: normal except for WBC 13. Hb normal at 12.6
  • Chem-7: normal except for bicarb of 38, sodium 130, glucose 155
  • Imaging: CT abdomen. Upper cut shown below.

What is the imaging diagnosis?