Dull Chest Pain in a 42-Year-Old Man

Ryland P. Byrd, Jr, MD; Thomas M. Roy, MD

Disclosures

June 12, 2017

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 that you would like to suggest for a future Case Challenge, please contact us.

Background

A 42-year-old man presents to the hospital with dull, anterior precordial and retrosternal chest pain that began acutely with a tearing sensation and has lasted for 3 days. He states that during this period he has been unable to "get comfortable." The intensity of the pain increases during inspiration and with body movement.

The patient denies any symptoms of recent viral infection, and he has received no recent vaccinations. He has no reported history of hypertension, coronary artery disease, prior cardiac surgery, diabetes mellitus, or hyperlipidemia. He has no family history of cardiovascular disease. The patient is taking no prescribed medication, over-the-counter medication, or herbal remedies, and he denies illicit drug use.

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