Page 129 - JSOM Winter 2017

An Ongoing Series

Pleuritic Chest Pain

This Can’t Be Happening!

2
Rory Farrell, SOIDC ; Christopher Dare, SOIDC ; Katarzyna (Kasia) Hampton, MD *
1
3

our team is being deployed to Africa. One of your team- Figure 1 Coronal view of the right lower chest.
Ymates has had a respiratory infection for the past week.
A few hours after a 14-hour flight, he comes to you report-
ing shortness of breath and pain on the right side of his chest
whenever he takes a deep breath.

You evaluate this otherwise healthy 29-year-old male starting
with a set of vital signs:
Heart rate 90 beats/min, blood pressure 120/65mmHg, re-
spiratory rate 24/min, Spo 95% on room air, temperature
2
38.0°C (100.4°F)
On physical examination, the patient is taking shallow breaths
but he is not in respiratory distress. He is warm to touch, and
he has notably decreased breath sounds over the lower right
lateral side of his chest. The reminder of his examination is
unremarkable.

As part of your evaluation, you obtain an ultrasound of his 2. What dynamic findings pathognomonic for this diagnosis
lungs. While viewing a dynamic clip, you are able to make a would you expect to see in Video 1 (online)?
diagnosis (Figure 1, Video 1 online). 3. What is the Pulmonary Embolism Rule-out Criteria (PERC)
rule, and how does it help you in this case?
1. What is the most likely diagnosis, and what suggestive find-
ings are present in Figure 1? Join us at SOFsono.org for further case discussion.

Address correspondence to sofsono.org@gmail.com
1 PO1 Farrell is a Special Amphibious Reconnaissance Corpsman (SARC) and is currently the Leading Petty Officer for the 1st Force Reconnais-
sance Detachment. CPO Dare is a Special Operations Independent Duty Corpsman (SOIDC) and is currently the Navy Senior Enlisted Leader
2
3
at 1st Reconnaissance Battalion. Dr Hampton is an emergency physician and a volunteer subject matter expert ultrasound instructor for the
military medical community. She is currently practicing at the Landstuhl Regional Medical Center, Germany (US Army Medical Department).
127