Intended for healthcare professionals

Endgames Spot Diagnosis

What is the diagnosis?

BMJ 2016; 353 doi: (Published 29 April 2016) Cite this as: BMJ 2016;353:i2394
  1. Mathew Tate, core trainee year 2 in cardiology and general internal medicine1,
  2. Simon Dubrey, consultant cardiologist1
  1. 1Department of Cardiology, Hillingdon Hospital, Uxbridge, UK
  1. Correspondence to: S Dubrey simon.dubrey{at}

A 55 year old man had chest and abdominal discomfort after a long haul flight. The chest discomfort resembled his usually stable angina pectoris. On admission his heart rate was 90 beats/min and his blood pressure was 95/52 mm Hg. Electrocardiography showed T wave inversion in the inferolateral leads, compatible with ischaemia, although serum troponin and D-dimer tests were negative. His arterial blood gases, pH, and lactate were normal. What does the supine abdominal radiograph show and what sign suggests the diagnosis (fig 1)?

Fig 1 Supine abdominal radiograph


The radiograph shows numerous round …

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