Pleuritic Chest Pain in the Emergency Department: Going through the differential diagnosis

2019 ◽  
Vol 14 ◽  
pp. 22-23.e1
Author(s):  
Yale Tung-Chen ◽  
Jorge Short-Apellániz ◽  
Enrique Moral-Coro
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Pleuritic Chest Pain

Acute Pericardial Fat Necrosis

2010 ◽  
pp. 305-308
Author(s):  
Edward C. Rosenow
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Fat Necrosis ◽  
Pleuritic Chest Pain ◽  
Pericardial Fat

• Mostly left-sided • Affects females more than males • Acute severe pleuritic chest pain ∘ Differential diagnosis • Myocardial infarction • Pericarditis • Pulmonary embolism • Obesity may or may not be present • On CT, necrosis produces irregularity mimicking neoplasm but also fat density...

scholarly journals Previously undiagnosed scoliosis presenting as pleuritic chest pain in the emergency department – a case series and a validating retrospective audit

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gabor Xantus ◽  
Derek Burke ◽  
Peter Kanizsai
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Chest Wall ◽  
Adult Population ◽  
Case Series ◽  
Sudden Onset ◽  
Pleuritic Chest Pain ◽  
Record System ◽  
Diverse Range ◽  
Retrospective Audit

Abstract Background Chest pain is one of the commonest presenting complaints in urgent/emergency care, with a lifelong prevalence of up to 25% in the adult population. Pleuritic chest pain is a subset of high investigation burden because of a diverse range of possible causes varying from simple musculoskeletal conditions to pulmonary embolism. Case series Among otherwise fit and healthy adult patients presenting in our emergency department with sudden onset of unilateral pleuritic chest pain, within 1 month we identified a cohort of five patients with pin-point tenderness in one specific costo-sternal joint often with referred pain to the back. All cases had apparent and, previously undiagnosed mild/moderate scoliosis. Methods To confirm and validate the observed association between scoliosis and pleuritic chest pain, a retrospective audit was designed and performed using the hospital’s electronic medical record system to reassess all consecutive adult chest pain patients. Results The Odds Ratio for having chest pain with scoliosis was 30.8 [95%CI 1.71–553.37], twenty times higher than suggested by prevalence data. Discussion In scoliosis the pathologic lateral curvature of the spine adversely affects the functional anatomy of both the spine and ribcage. In our hypothesis the chest wall asymmetry enables minor slip/subluxation of a rib either in the costo-sternal and/or costovertebral junction exerting direct pressure on the intercostal nerve causing pleuritic pain. Conclusion Thorough physical examination of the anterior and posterior chest wall is key to identify underlying scoliosis in otherwise fit patients presenting with sudden onset of pleuritic pain. Incorporating assessment for scoliosis in the low-risk chest pain protocols/tools may help reducing the length of stay in the emergency department and, facilitate speedy but safe discharge with increased patient satisfaction.

scholarly journals Pulmonary Embolism presenting as Syncope

2015 ◽  
Vol 12 (1) ◽  
pp. 37-41
Author(s):  
Dipak Mall ◽  
Yang Shaning
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Cardiac Care ◽  
Appropriate Treatment

The diagnosis of Pulmonary embolism can easily be missed if it is not considered as one of the major differential diagnosis in a case of syncope without chest pain. We describe a case of a 74years old female with pulmonary embolism induced syncope, which highlights one of the difficulties in diagnosing pulmonary embolism. In a patient presenting in syncope without chest pain but raised troponin, the possibility of pulmonary embolism should also be considered if it does not fit with myocardial infarction. Otherwise, the diagnosis can be easily missed and patients may not receive appropriate treatment resulting in increased mortality. Pulmonary embolism should be considered in the differential diagnosis of every syncopal event in Emergency department and Cardiac care units. DOI: http://dx.doi.org/10.3126/njh.v12i1.12343 Nepalese Heart Journal Vol.12(1) 2015: 37-41

scholarly journals Woman with dyspnea and history of systemic lupus erythematosus

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Nicolas Kahl ◽  
◽  
Sukhdeep Singh ◽  
Jessica Oswald ◽  
◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Emergency Department ◽  
Chest Pain ◽  
Lupus Erythematosus ◽  
Lower Leg ◽  
Shortness Of Breath ◽  
Pleuritic Chest Pain ◽  
Systemic Lupus ◽  
Blood Clots ◽  
History Of

32-year-old woman with history of pleurisy and systemic lupus erythematosus presented to the emergency department with shortness of breath and pleuritic chest pain, acutely worse over one day after a six hour flight three days prior. She became dyspneic walking from her hotel bed to the bathroom. She endorsed 3 weeks of right lower leg cramping. She denied history of blood clots. She appeared tachypneic and speaking in short phrases upon arrival. A bedside ultrasound was performed, see Figures. Vitals: T: 98.3 F, HR: 130, BP: 142/88, RR: 24, oxygen saturation 97% on room air.

scholarly journals 50-year-old Male With Chest Pain

2019 ◽  
Vol 3 (4) ◽  
pp. 321-326
Author(s):  
William Fernandez ◽  
Laura Bontempo ◽  
Zachary Dezman
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Troponin I ◽  
Shortness Of Breath ◽  
Upper Limit ◽  
Work Up

A 50-year-old male presented to the emergency department with four days of intermittent chest pain and shortness of breath, which progressively worsened in severity. Testing revealed a troponin I greater than 100 times the upper limit of normal and an electrocardiogram with non-specific findings. This case takes the reader through the differential diagnosis and systematic work-up of the deadly causes of chest pain, ultimately leading to this patient’s diagnosis.

scholarly journals Information technology tools can automate imaging measures for Emergency Department patients with suspected pulmonary embolism

2019 ◽  
Author(s):  
Vlad I Valtchinov ◽  
Ivan Ip ◽  
Ramin Khorasani ◽  
Laila Cochon ◽  
Ronilda Lacson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Language Processing ◽  
Signs And Symptoms ◽  
Pulmonary Angiography ◽  
Audit And Feedback ◽  
Pleuritic Chest Pain ◽  
Suspected Pulmonary Embolism ◽  
Ed Visits

Abstract CT pulmonary angiography (CTPA) utilization rates for patients with suspected pulmonary embolism (PE) in the Emergency Department (ED) have increased steadily with associated radiation exposure, costs and overdiagnosis. A new measure is needed to more precisely assess efficiency of CTPA utilization normalized to numbers of patients presenting with suspected PE, based on patient signs and symptoms. This study used natural language processing (NLP) to develop, automate, and validate SPE (“Suspected Pulmonary Embolism [PE]”), a measure determining CTPA utilization in ED patients with suspected PE. This retrospective study was conducted 4/1/2013-3/31/2014 in a Level-1 ED. A NLP engine processed “Chief Complaint” sections of ED documentation, identifying patients with PE-suggestive symptoms based on four Concept Unique Identifiers (CUIs: shortness of breath, chest pain, pleuritic chest pain, anterior pleuritic chest pain). SPE was defined as proportion of ED visits for patients with potential PE undergoing CTPA. Manual reviews determined specificity, sensitivity and negative predictive value (NPV). Among 5,768 ED visits with 1+SPE CUI, and 795 CTPAs performed, SPE=13.8% (795/5,768). NLP identified patients with relevant CUIs with specificity=0.94 [95%CI (0.89-0.96)]; sensitivity=0.73 [95%CI (0.45-0.92)]; NPV=0.98. Using NLP on ED documentation can identify patients with suspected PE to computate a more clinically-relevant CTPA measure. This measure might then be used in an audit-and-feedback process to increase the appropriateness of imaging of patients with suspected PE in the ED.

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