Review Question - QID 213420

A 56-year-old man is brought to the emergency room for severe chest pain over the past hour. He reports 10/10, burning pain that is retrosternal and concentrated around the mid-chest region. His wife claims that he has been throwing up for the past several hours from what seems like a “stomach bug,” with the latest 2 episodes of emesis being bright red. The patient denies trauma, fever, recent infections, urinary changes or diarrhea but endorses lightheadedness and shortness of breath. His past medical history is significant for hypertension and diabetes. A computed tomography (CT) with IV and oral contrast of the chest and abdomen is obtained and its results are shown in Figure A. What is the most specific physical examination findings for this patient’s diagnosis?