A Marijuana User With Sudden Chest Pain Radiating to His Neck

Ingrid Chen, MD; Dieu-Thu Nguyen-Khoa, MD


June 11, 2021

Editor's Note:

The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


An 18-year-old with no significant medical history presents to the emergency department with sudden-onset chest pain that awakened him from sleep at 4 AM. The pain is located in the midsubsternal region and radiates to his neck. The patient describes it as a sharp pain; when asked to rate the pain on a scale of increasing severity from 1 to 10, he states that it is an 8. The pain worsens with inspiration and is associated with shortness of breath.

The patient denies having any fevers, chills, cough, hemoptysis, nausea, or vomiting. He has not had any recent trauma or surgeries. The patient has an 8–pack-year history of smoking cigarettes. He describes occasional marijuana use and remote experimentation with inhaled methamphetamines. He states that he does not use alcohol. He is not currently taking any medications and does not have any known allergies to medications.


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