Pericardial fat necrosis presenting as acute pleuritic chest pain

Autor: Annick Lavoie, Julie Prenovault, Carl Chartrand-Lefebvre, Marie-Constance Lacasse
Rok vydání: 2012
Předmět:
Zdroj: The Journal of emergency medicine. 44(2)
ISSN: 0736-4679
Popis: A 58-year-old man presented to the Emergency Department with a 4-day history of acute and progressive left pleuritic chest pain. The chest pain appeared suddenly, awakening the patient in the middle of the night. There was no history of trauma or associated dyspnea. Pain was not entirely relieved by non-steroidal anti-inflammatory drugs (NSAIDS). Prior medical history was relevant for diabetes, hypertension, and dyslipidemia. There were no risk factors for pulmonary embolus. On examination, the patient was cooperative and alert. Vitals signs were normal. Physical examination revealed decreased air entry in the left lower lung. Calves were non-tender and not swollen. The initial chest X-ray study showed a rise of the left hemidiaphragm and small left pleural effusion (Figure 1). Laboratory values were normal, with negative cardiac enzyme levels and D-dimers. The electrocardiogram (ECG) showed a normal sinus rhythm with a right bundle branch block, the exact same result as an ECG done 5 years prior (Figure 2). The patient’s pain was relieved by morphine. Probability for pulmonary embolus was intermediate at ventilation-perfusion scintigraphy, which demonstrated a ventilation-perfusion mismatch in the lateral basal segment of the left lower lobe. Intravenous heparin was started. Due to the result of lung scintigraphy, a pulmonary computed tomography (CT) angiography was requested. CT angiography did not show any signs of pulmonary embolism, although distal vascular evaluation at both lung bases was limited due to respiratory artifacts.
Databáze: OpenAIRE
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