CASE73:CHEST PAIN AND SHORTNESS OF BREATH
History
A 25-year-old female accountant complains of shortness of breath, cough and chest pain.
The chest pain came on suddenly 6 h previously when she was walking to work. It was a
sharp pain in the right side of the chest. The pain was made worse by breathing. It settled
over the next few hours but there is still a mild ache in the right side on deep breathing.
She felt a little short of breath for the first hour or two after the pain came on but now
only feels this on stairs or walking quickly. She has had a dry cough throughout the 6 h.
She smokes 15 cigarettes a day and drinks 10 units of alcohol a week. She uses marijuana
occasionally. She is on no medication. Four years ago something very similar happened;
she is not sure but thinks that the pain was on the left side of the chest on that occasion.
There is no relevant family history.
Examination
She is not distressed or cyanosed. Her pulse is 88/min and blood pressure 128/78 mmHg, res-
piratory rate is 20/min. Heart sounds are normal. In the respiratory system the trachea and
apex beat are not displaced. Expansion seems normal, as is percussion. There is decreased
tactile vocal fremitus and the intensity of the breath sounds is reduced over the right side of
the chest. There are no added sounds on auscultation.
The chest X-ray is shown in Fig. 73.1.INVESTIGATIONS
Figure 73.1Chest X-ray.Questions
- What does the X-ray show?
- What should be done now?