Haisook
Forum Junior
Topics: 12
Posts: 70
|
Hi all.
My friend sent me this interesting case. Unfortunately, there's no choice of answers with it. What do you think is the most likely disease to be associated with this case?
------------------------------------
A 21-year-old man has been experiencing intermittent chest pain over the last 72 hours. It all started 2 days ago when he was using his computer as sudden stabbing localized pain around the left 2nd intercostal space. Actually, he's experienced such pain episodes before (very rarely), but the dull pain would go away in a minute. This time, however, it kept hurting for more than an hour. The pain was dull and minimal. He had no sweating nor palpitations. The pain did not radiate to anywhere. It would hurt if he pressed against the said area of pain (i.e. tenderness).
After the said hour, the pain was no more present. The next day he woke up normally as he always do. However, in the late afternoon he felt a subtle dull pain in the same area. It was tender also. It seemed that the more he thinks it's a serious thing (i.e. MI), the more it seems to be stronger and hurt more. The next day he felt a dull 'itchy' pain in the same area and left to it. Between such episodes, he feels perfectly normal.
The patient was diagnosed with hypercholesterolemia 7 years ago. His BMI is within the normal range and he seems healthy. The physical examination is also unremarkable except for a tenderness over the said area.
------------------------------------
What do you think about this case?
I've just read the "Primary Antiphospholipid Syndrome" article here; I've also read some articles on "Transitory Benign Chest Wall Pain" and "Precordial catch syndrome" that I wonder if he have any of them. If not, could it be a true MI? If so, what other symptoms is he supposed to notice?
Lastly, what's the next step to be done?
I'd appreciate your opinions. Thanks.
___________________
-- USMLE-preparing med student from Egypt ---- My medical website: Medicopedia - the medical show!
|
| neurom
Forum Senior
Topics: 2
Posts: 127
|
Well, it can be ANYTHING. As we don't have any diagnostic interventions done, first, we need to rule out MI - EKG, CXR - to see what's going on in his lungs and mediastinum, CBC and then act appropriately.
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
|
| Haisook
Forum Junior
Topics: 12
Posts: 70
|
Is it possible for a myocardial ischemic pain to persist for days? or remit and relapse over days?
___________________
-- USMLE-preparing med student from Egypt ---- My medical website: Medicopedia - the medical show!
|
| neurom
Forum Senior
Topics: 2
Posts: 127
|
Haisook wrote:
Is it possible for a myocardial ischemic pain to persist for days? or remit and relapse over days?
I think it is very unlikely, but we HAVE TO RULE IT OUT anyway.
Arlete - waiting for your opinion
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
|
| dr.wad
Forum Senior
Topics: 3
Posts: 335
|
could be Tietze syndrome( costochondritis )
neurom said u have to exclude other causes.
|
| mildus
Forum Guru
Topics: 19
Posts: 614
|
If the pain increases on touching that place, it usually indicates that the pain originates from the chest wall (musculoskeletal or skin pain)
|
| mildus
Forum Guru
Topics: 19
Posts: 614
|
of course, it doesn't mean that we don't have to rule out other more dangerous possibilities
|
| Haisook
Forum Junior
Topics: 12
Posts: 70
|
Since we're talking about the likelihood, not the actual diagnosis, i.e. thinking somewhat epidemiologically, I'm with dr.wad -- it's more likely a costochondral syndrome (costochondritis) given the patient's age and the pain character (stabbing or dull persistent, localized, and can be reproduced manually).
By the way, what are the causes of costochondritis?
___________________
-- USMLE-preparing med student from Egypt ---- My medical website: Medicopedia - the medical show!
|
| neurom
Forum Senior
Topics: 2
Posts: 127
|
yes it can be costochondritis as well
causes:
injury
infection, especially after surgery, the cartilage becomes more prone to bacterial infection
fibromyalgia
also, it can be referred pain.
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
|
| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,227
|
It's not typical for anything... I would think costochondritis, too, specially because it's tender on local palpation.
But it could be a spontaneous pneumothorax, too. Because of the age, the multiple episodes... If it's very small, it hurts just like that, where the blebs are, and it does not cause dyspnea. (Actually, I've seen a case just like that in my practice, the patient had a CRX - there it was.)
Myocardial ischemia at this age is very, very rare, and the ones I saw were all related to cocaine use, with typical presentation. One could think about a congenital coronary anatomical anomaly, but I think the presentation would be typical, too (pain during increased O2 demand).
___________________
When men make the rules, God decides the exceptions.
|
| Vietnamese
Forum Elite
Topics: 12
Posts: 285
|
He can had a Pain Disorder, a subtype of somatoform disorder. Why not?
___________________
Nothing is impossible.
|
| drduck
Forum Guru
Topics: 82
Posts: 529
|
yes very difficult to make out.
it is more non cardiac lesion.....as tendrness at the site of pain turns diagnosis away from MI.
but as per the protocol....think of MI and go for necessary investigations,
seems bony lesion....costocondritis....
|
|
| |
| | | | | | | | | | | | |
