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Assembly

Acute Onset Shortness of Breath, Pleuritic Chest Pain, and Cough

Authors
Slostad, JA1, Higgins, AS1, Dempsey TM2, Dunn WF2
1Department of Internal Medicine, 2Department of Pulmonary and Critical Care Medicine
Mayo Clinic, Rochester, Minnesota, USA


Case

A 65-year-old non-smoking female presented to the emergency department with one week of dyspnea, pleuritic chest pain, and dry cough.

On exam, she was afebrile, hemodynamically stable with blood pressure 150/77, oxygen saturation of 92% on room air, and respiratory rate of 22. She had shallow work of breathing with right-sided absent breath sounds in the mid and lower lung base. She had several white dome-shaped papules scattered over her forehead and face. Cardiac, neurologic, and abdominal exams were unremarkable. Family history was significant for a brother with tension pneumothorax requiring pleurectomy. Chest x-ray was obtained (Figure 1).

Figure 1: Chest x-ray obtained in Emergency Department:
Chest x-ray obtained in Emergency Department:

Question

What is the most likely cause of her acute onset of shortness of breath, pleuritic chest pain, and dry cough?

A. Malignant pleural effusion
B. Primary pneumothorax
C. Secondary pneumothorax with tension physiology
D. COPD exacerbation
E. Community acquired pneumonia

Answer