A man in his 60s with a medical history of compensated cirrhosis secondary to chronic hepatitis C virus infection and diabetes mellitus presented to the ED complaining of 2 days of shortness of breath and substernal chest pain radiating to his back.
In the ED, the patient had a systolic BP of 60 mm Hg, a heart rate of 110 beats/min, and a respiratory rate of 16 breaths/min; he was afebrile. Results of the rest of the physical examination were normal. His BP improved after receiving 3 L of normal saline. The results of laboratory tests at admission are presented in Table 1. His chest roentgenogram (Fig 1), ECG (Fig 2), and cardiac enzyme test results were unremarkable. A CT angiogram of the chest, abdomen, and pelvis, performed in the ED to evaluate for pulmonary embolism and aortic dissection, demonstrated neither condition. There were scattered areas of bibasilar atelectasis (Fig 3). The patient was subsequently admitted to the inpatient medical ward for further evaluation.