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Updated 30 July 2015

What's your diagnosis? – Case 20: chest pain next to breastbone

Mr Q, a 45-year-old accountant and avid mountain biker, has right-sided chest pain just next to his breastbone (sternum). See if you can unravel this week's case.

1

Mr Q, a 45 year old accountant, consults his GP about sudden-onset right sided chest pain. His pain is located to the right of his breastbone (sternum).

The following is a summary of the GP's medical notes:

Sudden-onset right sided chest pain; pain not radiating; described as dull, occasionally sharp pain; started a day ago

Pain worse when breathing in and out

No history of shortness of breath, excessive sweating or nausea and vomiting

Had bronchitis one week ago; used antibiotic; infection cleared

History

Family history: mother suffers from hypertension; father passed away due to heart attack (myocardial infarction)

Medical history: anti-hypertensive treatment (patient unsure what medication he is using)

Surgical history: none

Social: smoker, uses alcohol once a week

On Examination

Generally calm, only complains of pain on breathing in

Not pale, not dehydrated, no oedema

Chest: clear, good, equal, air-entry both sides of chest

Normal heart rhythm, no signs of heart failure

Tender over right side of rib cage : especially over ribs 4 and 5

Rest of examination clear

Side room: heart rate: 88; blood pressure: 160/89; urine: clear

Based on the above information, answer the following questions to make a possible diagnosis:

1.  Is the pain typically what you would expect with cardiac disease?

2.  What structures make up the:

- Chest wall

- Chest cavity

3.  What special investigation will help you make a diagnosis? Choose two:

-CT Scan

-ECG

-Chest X-ray

-Bloods, including a full blood count, electrolyte panel and cardiac markers

4.  Should Mr Q be admitted to hospital?

5. What is the most likely cause of Mr Q's symptoms?

6. How would you approach his treatment plan?

What's your diagnosis? Join the guesswork on our Facebook page, or comment below.

NOTE: Health24's on-site GP Dr Owen Wiese will reveal new cases on Thursdays. We'll post the answer with the story on Mondays, or you can get it via the Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

Image: chest pain, Shutterstock

 
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