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📋 Radiology Case A 62-year-old man presents to the emergency department with sudden-onset, excruciating epigastric pain that started 2 hours ago. He reports taking over-the-counter naproxen daily for osteoarthritis. Vital signs are temperature 38.0°C (100.4°F), blood pressure 102/64 mmHg, pulse 115/min, and respirations 22/min. Physical examination reveals a board-like, rigid abdomen with involuntary guarding and rebound tenderness across all quadrants. Bowel sounds are absent. An upright chest radiograph is performed.