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Postgraduate Education Corner: Ultrasound Corner |

A 44-Year-Old Man With Progressive Shortness of Breath and Left-Sided Pleuritic Chest PainShortness of Breath and Left-Sided Chest Pain

Sandeep Khosa, MD; Grace Dosanjh, MD; Vidya Krishnan, MD; Ziad Shaman, MD, FCCP
Author and Funding Information

From the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs Khosa, Krishnan, and Shaman), MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; and the Department of Gastroenterology and Hepatology (Dr Dosanjh), Mayo Clinic, Rochester, MN.

Correspondence to: Sandeep Khosa, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, Bell-Greve Third Floor, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; e-mail: skhosa@metrohealth.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(4):e1-e4. doi:10.1378/chest.13-0803
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Extract

A 44-year-old man presented to our ED with progressive shortness of breath and left-sided pleuritic chest pain. His history was remarkable for alcohol and tobacco abuse. On examination, his vital signs were stable except for sinus tachycardia (119 beats/min). Laboratory values for cardiac markers were within normal limits, and chest roentgenogram was notable for a wedge-shaped infiltrate (Fig 1). Acute pulmonary embolism (PE) was suspected, and CT pulmonary angiography (CTPA) was performed. The CTPA showed multiple PEs in segmental branches and wedge-shaped infarcts in the bilateral lower lobes (Fig 2). In addition, a mass was noted near the periphery of the right hepatic lobe, suspicious for a malignancy (Fig 3). The patient was treated for acute PE with heparin and transitioned to warfarin. In addition, investigations were undertaken to further characterize the liver mass. Biopsy of the liver mass was deferred because of the immediate need for anticoagulation and was scheduled to be obtained as an outpatient. The patient was discharged with improvement in his symptoms.

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Bedside ultrasound

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Right ventricle

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