<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 64-year-old man is brought to the emergency department because of a 2-hour history of nausea, vomiting, and retrosternal pain that radiates to the back. Abdominal examination shows tenderness to palpation in the epigastric area. A CT scan of the patients chest is shown. Which of the following is the most likely diagnosis?? A: Esophageal rupture, B: Pulmonary embolism, C: Pneumothorax, D: Mallory-Weiss syndrome, E: Aspiration pneumonia,  <response>: This is a clinical vignette describing a 64-year-old man with acute onset nausea, vomiting, and retrosternal chest pain radiating to the back. The description of the pain and the epigastric tenderness on exam point towards an upper GI source. The CT scan shows pneumomediastinum, which is air in the mediastinal space around the esophagus. This finding, along with the clinical presentation, is most consistent with esophageal rupture Boerhaave syndrome. Pneumothorax, pulmonary embolism, and aspiration pneumonia would not cause epigastric pain and tenderness. Mallory-Weiss syndrome can cause vomiting and epigastric pain, but would not cause pneumomediastinum on CT scan. Therefore, the most likely diagnosis is esophageal rupture.A: Esophageal rupture 