Physical Examination and Workup
Upon examination, the patient is pale and appears to be in moderate distress due to the chest pain. His temperature is 99.5 °F (37.5 °C); respiration rate is 22 breaths/min, with a peripheral capillary oxygen saturation of 94% on room air; heart rate is 104 beats/min; and blood pressure is 140/88 mm Hg. His body mass index (BMI) is 32 kg/m2.
The cardiac examination reveals tachycardia, minimal tenderness to palpation, and normal heart sounds, with no murmurs. No bruits are audible on auscultation of the carotid arteries. The supraclavicular lymph nodes are notable bilaterally. The respiratory system is grossly clear to auscultation bilaterally, except for reduced air entry at the lung bases. The abdomen is nondistended, nontender, and obese, with hyperactive bowel sounds. Mild +1 bilateral pedal edema is noted from the mid-tibial region down to the ankles. Peripheral pulsations are intact. The remainder of the physical examination results are unremarkable.
Laboratory investigations reveal these values:
Hemoglobin level: 10.1 g/dL (reference range, 13.5-17.5 g/dL)
Hematocrit: 29.6% (reference range, 41%-50%)
White blood cell count: 5800 cells/µL (reference range, 4000-11,000 cells/µL), with 63% neutrophils and 27% lymphocytes
Platelet count: 200,000 cells/µL (reference range, 150,000-400,000 cells/µL)
Mean corpuscular volume and mean corpuscular hemoglobin concentration are reduced. The initial troponin level is 0.012 ng/mL (reference range, 0-0.4 ng/mL), and a repeated level obtained 4 hours later is 0.016 ng/mL.
The results of a basic metabolic panel are:
Sodium: 134 mmol/L (reference range, 135-145 mmol/L)
Potassium: 3.4 mmol/L (reference range, 3.7-5.2 mmol/L)
Chloride: 100 mmol/L (reference range, 96-106 mmol/L)
Bicarbonate: 40 mmol/L (reference range, 23-29 mmol/L)
Blood urea nitrogen: 40 mg/dL (reference range, 8-24 mg/dL)
Creatinine: 0.7 mg/dL (reference range, 0.9-1.3 mg/dL)
The total serum protein level is 6.2 g/dL (reference range, 6.0-8.3 g/dL), and the albumin level is 3.4 g/dL (reference range, 3.5-5.5 g/dL). Liver function test results are within normal limits. The D-dimer level is 152 ng/mL (reference range, < 250 ng/mL).
An ECG shows sinus tachycardia, and a chest radiograph is obtained. The Figure reveals similar radiographic findings in a different patient. A CT angiography (CTA) of the chest is ordered, and the results are pending.
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