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Pleuritic Back Pain

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A woman in her 50’s with a history of RA presents to the ED for 3 days of pleuritic left upper back pain without fever, SOB or chest pain or cough.

Vital Signs & Physical Exam:

Vital signs are normal except for   Physical exam is otherwise normal except for bilateral rales

Initial Differential Diagnosis: 

Relevant Test Results:

  • EKG: normal
  • Labs: CRP 25, Ddimer 1600, CBC, normal
  • Imaging: a CHEST x-ray is done

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows pulmonary fibrosis. See CT scan below

    No evidence of pulmonary embolism. Diffusely abnormal lung parenchyma, with findings compatible with honeycombing and fibrosis

  2. What should you do next?  Treat with.  Consult.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: We’ll just have to see

CASE LESSONS:

  1. Always
  2. Never

    ?No CT evidence of pulmonary embolism.

    2. ?Diffusely abnormal lung parenchyma, with findings compatible with honeycombing and fibrosis

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