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.

Picture Quiz: A Case of Sudden Severe Chest Pain

2007 ◽  
Vol 6 (1) ◽  
pp. 27-27
Author(s):  
Mustafa Abu Rabia ◽  
◽  
P Sullivan ◽  
Stavros M Stivaros. ◽  
◽  
...  
Keyword(s):  
Chest Pain ◽  
Medical History ◽  
Chest Wall ◽  
Epigastric Pain ◽  
Anterior Chest Wall ◽  
Sudden Onset ◽  
Severe Chest Pain ◽  
History Of ◽  
Previous Medical History

An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting.

scholarly journals Profile of the Population Cared for in a Referral Emergency Unit

2011 ◽  
Vol 19 (3) ◽  
pp. 548-556 ◽  
Author(s):  
Gabriella Novelli Oliveira ◽  
Michele de Freitas Neves Silva ◽  
Izilda Esmenia Muglia Araujo ◽  
Marco Antonio Carvalho-Filho
Keyword(s):  
Emergency Department ◽  
Young Adults ◽  
Back Pain ◽  
Retrospective Study ◽  
Chest Pain ◽  
Young Women ◽  
Adult Population ◽  
Low Complexity ◽  
University Hospital ◽  
Emergency Unit

Acquiring knowledge concerning the characteristics of the population that seeks an emergency department can support the planning of health actions. This study identifies the socio-demographic profile and the main complaints of the adult population cared for in a Referral Emergency Unit (RECU). This descriptive and retrospective study was conducted in the RECU of a university hospital in the State of Sao Paulo, Brazil. The sample was composed of the service’s care forms generated for the period between January and December 2008. The instrument was based on data contained in the care forms. Young women (14 to 54 years old), residents of neighborhoods near the RECU, spontaneously sought the service during the week from 7am to 7pm. The most frequent complaints were headache, back pain, abdominal and chest pain. The conclusion is that most of the sample was young adults, of productive age, female, who spontaneously sought the service on weekdays during the day. Most complaints were of low complexity.

scholarly journals An unusual cause of ‘pleuritic’ chest pain

2008 ◽  
Vol 7 (2) ◽  
pp. 80-82
Author(s):  
Evelyn S Tan ◽  
◽  
Pierre J Willemse ◽  
Ahmed H Abdelhafiz ◽  
◽  
...  
Keyword(s):  
Chest Pain ◽  
Exercise Tolerance ◽  
Sudden Onset ◽  
Smoking History ◽  
Isosorbide Mononitrate ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
Intravenous Morphine ◽  
Drug History ◽  
History Of

A 77 year old man presented to A&E with sudden onset left sided chest pain. This chest pain was severe enough to wake him up from sleep in the early hours of the morning. The pain was pleuritic in nature and severe enough to require administration of intravenous morphine. He had a past medical history of ischaemic heart disease (1997), pulmonary embolism (1997), and left sided pnuemothorax (1998). Drug history consisted of lansoprazole 30mg od, isosorbide mononitrate 60mg od, nicorandil 10mg bd, aspirin 75mg od, beclomethasone 100 inhaler 1 puff bd, salbutamol 100 inhaler prn and combivent nebuliser qds. He was a retired miner, having worked for 40 years underground. There was also a 20 pack year smoking history although he had stopped for 20 years. He was independent and had a 100 to 200 yard exercise tolerance on the flat. Observations showed respiratory rate of 18, temperature of 36.5 degrees Celsius, BP 133/69, oxygen saturation of 98% on air and a regular pulse of 70 beats per minute. Clinical examination did not reveal any abnormality, with no abdominal or chest wall tenderness.

scholarly journals Pleurisy Can Cause Chest Wall Tenderness: A Case Report

2020 ◽  
Author(s):  
Shaul Yaari ◽  
Elchanan Juravel ◽  
Murad Daana ◽  
Samuel Noam Heyman
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Chest Wall ◽  
Musculoskeletal Pain ◽  
Pulmonary Thromboembolism ◽  
Lower Lobe ◽  
Spinal Reflex ◽  
Pleuritic Chest Pain ◽  
Pain Evaluation ◽  
Local Tenderness

Stab-like localized chest pain, aggravated by breathing, is compatible with pleuritic pain or with aching related to chest wall abnormalities. Local tenderness inflicted by palpation helps to differentiate pleuritic from musculoskeletal chest pain and serves as a principal accessory manoeuvre in the algorithm of chest pain evaluation. Herein, we report the case of a 27-year-old patient with pulmonary thromboembolism and right lower lobe consolidation/atelectasis. The patient presented with right-sided chest pain, radiating to the shoulder, related to pleural irritation, yet associated with confounding intense chest wall tenderness and guarding, also involving the costovertebral angle. We propose that spinal reflex-related chest wall tenderness was involved, similar to peritoneal signs evoked by irritation of the parietal peritoneum. This case report illustrates that localized chest wall tenderness and guarding, triggered by palpation, may not serve as unequivocal indicators of musculoskeletal pain, and could be unrecognized features of pleuritic chest pain also.

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 Endometriosis: An Unusual Cause of Bilateral Pneumothoraces

2020 ◽  
Vol 4 (1) ◽  
pp. 35-37
Author(s):  
Christopher Sampson ◽  
Kathleen White
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Respiratory Distress ◽  
Chest Radiograph ◽  
Spontaneous Pneumothorax ◽  
Sudden Onset ◽  
Shortness Of Breath ◽  
Pelvic Endometriosis ◽  
Catamenial Pneumothorax

A 27-year-old female presented to the emergency department with sudden onset shortness of breath. A diagnosis of bilateral catamenial pneumothoraces was made following chest radiograph. Catamenial pneumothorax is a recurrent spontaneous pneumothorax that occurs in 90% of affected women 24-48 hours after the onset of their menstruation; 30-50% of cases have associated pelvic endometriosis. Symptoms can be as simple as chest pain or as severe as the presentation of this patient who was initially found to be in significant respiratory distress.

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