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Postgraduate Education Corner: Ultrasound Corner |

A Man in His 40s With Fever and HypotensionA Man With Fever and Hypotension

Samir Raza, MD; Robert Arntfield, MD, FCCP
Author and Funding Information

From the Department of Internal Medicine (Dr Raza), McMaster University, Hamilton, ON; and Department of Critical Care and Emergency Medicine (Dr Arntfield), The University of Western Ontario, London, ON, Canada.

Correspondence to: Samir Raza, MD, Department of Internal Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada; e-mail: Samir.raza@medportal.ca


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


Chest. 2014;145(6):e17-e19. doi:10.1378/chest.13-1865
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Extract

A man in his 40s presented to the ED complaining of chills and rigors. He had undergone prostate biopsy earlier that day. The patient denied cough, purulent sputum, shortness of breath, nausea, vomiting, or chest pain. He had a medical history of hypertension and hypercholesterolemia for which he took metoprolol and atorvastatin, respectively. Six months previous, he was found to have elevated prostate-specific antigen levels, which led to the biopsy.

On presentation, the patient was flushed, diaphoretic, febrile (temperature, 39.4°C), tachycardic (heart rate, 119 beats/min), normotensive (BP, 141/78 mm Hg), and breathing comfortably on room air. Physical examination was otherwise unremarkable, showing a normal precordial examination; good breath sounds bilaterally without rales; a soft, nontender abdomen; and no signs of rash. Initial blood work was unremarkable. A portable chest radiograph showed no signs of pneumonia or heart failure (Fig 1).

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Figures

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Videos 1-6

Echo of case patient in emergency department

Discussion Video

Discussion Video 1

LV function

Discussion Video 2

Ultrasound of left thorax

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