An 86-year-old woman with a background of ischaemic heart disease presented with dysphagia and odynophagia while eating toast for breakfast followed by sudden onset severe sharp retrosternal and epigastric pain radiating to her back and 3 episodes of coffee-ground vomiting. There were no reported episodes of melaena or syncope. She remained haemodynamically stable. Her blood results showed haemoglobin 125 g/L, white cell count 11.2 x109/L, platelets 277 x109/L and prothrombin time 14s. She underwent emergency upper GI endoscopy. What do the images suggest?

Phey Shen Lee

Northumbria Healthcare NHS trust