4 cases of chest pain.

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Presentation transcript:

4 cases of chest pain

Man of 34 Just returned form 2 weeks in Turkey Flu like symptoms Cough Coughed up blood Pain right lower chest

On examination Temperature 38.4 Pulse 90 regular Chest Dullness to percussion right base BS present but added crackles and one area of coarse breathing Scratching sound too

What are the possible diagnoses? How might you distinguish between possible causes? What tests might help? What are the treatment options?

Pneumonia

Man of 22 Long standing asthma Develops sharp right sided chest pain whilst out walking the dog Becomes short of breath on exertion

On examination Thin Chest expansion reduced right side Percussion note resonant and possible more so right side Decreased air entry right apex of lung over clavicles

What are the possible diagnoses? What would explain this story and chest signs? Which factors might contribute to this problem? How might you confirm the diagnosis? Treatment options? He suddenly becomes much more short of breath – why?

Pneumothorax

Tension pneumothorax

Needle decompression

Chest drain

Man of 63 Smoker for many years History of dyspnoea on exertion Develops pain in left side of chest Cough

ON EXAMINATION Thin Clubbed Nicotine stains Percussion note dull left base Decreased breath sounds left base

How can you explain these signs What sort of pathology will cause dullness to percussion What might cause reduced air entry? What might you see on CXR?

Pleural effusion

Collapsed lung vs. effusion Where is trachea?

61 YEAR OLD MAN Just returned from 2 weeks in Turkey visiting his daughter Developed slight chest pain whilst there went to chemist and got antibiotics Coughed up blood No better

ON EXAMINATION Apyrexial Not clubbed P 110 regular RR 28 Chest – percussion note normal Normal air entry Loud second heart sound especially pulmonary area

What might explain his signs? Why is he tachycardic and tachypnoeic? What can cause someone to cough up blood? Why did the antibiotics not help? What are the risk factors for this man?

Pulmonary embolism

CT Pulmonary embolism

Perfusion Ventilation mismatch

Pulmonary angiogram

ECG Tachycardia S1 Q3 T3

Questions