Part 2 book “ABC emergency differential diagnosis” has contents: Chest pain – pleuritic, dizziness, the intoxicated patient, the shocked patient, low back pain, acute confusion, palpitations. | CHAPTER 10 Chest Pain – Pleuritic Claire Gardner and Kevin Jones CASE HI STO RY A 70-year-old lady presents with right-sided chest pain. The pain is sharp in nature and worse on deep inspiration. It is sometimes worse on movement and she had partial relief with co-codamol at home. Prior to going to bed yesterday evening she had felt perfectly well, although 1 week before then she had suffered with cough, green sputum and wheeze which her GP had treated with a course of amoxicillin. Today she feels hot and cold and has noticed some streaks of blood in her sputum. This prompted her to attend hospital. She had a total hip replacement 2 weeks ago and was discharged from hospital 1 week ago. Her leg is swollen after her surgery. She remembers having a minor injury 5 days ago when she bumped her right side on a chair. She has a past history of mild chronic obstructive pulmonary disease (COPD), osteoarthritis and hypertension. She takes amlodipine 10 mg daily, Seretide inhaler 250 µg two puffs twice daily, and salbutamol inhaler 100 µg as required. She has no allergies. She stopped smoking 10 years ago and has a 20 pack-year history. She lives with her husband and is normally independent. She does not drink alcohol. Her usual exercise tolerance is approximately 500 metres, but this is now limited to 50 metres over the last 3 days due to breathlessness. Pneumonia Pneumonia is one of the commonest causes of pleuritic chest pain. The definition of pneumonia includes symptoms and signs of a respiratory infection and new chest radiographic shadowing consistent with consolidation (see Figure ). Supportive features in the history are cough, yellow, green or brown sputum, fever, malaise, Table Causes of pleuritic chest pain. Common Uncommon Pneumonia Pulmonary embolism Pneumothorax Musculoskeletal chest pain Pericarditis Autoimmune diseases Myocardial infarction Aortic dissection Oesophageal rupture Pancreatitis Question: What differential diagnosis would you .
