<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 56-year-old man presents to the emergency department with severe epigastric pain that began an hour prior to presentation. He describes the pain as sharp, 1010 in severity, and radiating to the back. Swallowing worsens the pain and causes him to cough. Before the pain started, he had been vomiting multiple times per day for the past week. The emesis was yellow and he denied ever seeing blood. Medical history is significant for poorly controlled hypertension, type II diabetes, alcohol use disorder, and 2 prior hospitalizations for acute pancreatitis. He smokes 1 pack of cigarettes per day for the last 35 years, denies illicit drug use, and drinks 3 pints of vodka per day. On physical exam, there is mediastinal crackling in synchrony with cardiac contraction on cardiac auscultation in the left lateral decubitus position. Laboratory testing is significant for leukocytosis. Which of the following is most likely the cause of this patients symptoms?? A: Coronary artery occlusion, B: Dissection of the aorta, C: Inflammation of the pancreas, D: Ulcerative changes in the gastric mucosa, E: Transmural esophageal rupture,  <response>: This is a clinical vignette describing a 56-year-old man with severe epigastric pain radiating to the back, worsened by swallowing and causing cough. He has a history of vomiting, poorly controlled hypertension, diabetes, alcohol use disorder, and prior pancreatitis. On exam, he has a mediastinal bruit. The key findings are the epigastric pain radiating to the back, worsened by swallowing, history of pancreatitis, and mediastinal bruit. These point towards a diagnosis of esophageal rupture, likely due to repeated vomiting in the setting of alcohol use disorder. Coronary artery occlusion would not cause these symptoms. Aortic dissection could cause back pain but not the other findings. Pancreatitis would not explain the mediastinal findings. An ulcer would not cause a mediastinal bruit. Therefore, the most likely diagnosis is transmural esophageal rupture.E: Transmural esophageal rupture 