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- W155536303 abstract "A previously healthy 17-year-old boy awoke with left-sided pleuritic chest pain. He also noticed mild dyspnea on exertion during track-and-field practice but reported no sputum production, fever, chills, or recent trauma. Pleuritic chest pain reflects inflammation, irritation, or stretching of sensory-nerve fibers in the parietal pleura. Often, the process primarily involves the pleura, as in the case of pneumothorax, a pleural inflammatory or infectious process, or a tumor with pleural involvement. Alternatively, pleuritic pain can result from a pulmonary parenchymal process that extends to the visceral pleural surface and secondarily involves the parietal pleura, especially in the case of pneumonia or pulmonary embolus. The acute onset of pleuritic chest pain in an otherwise healthy teenager suggests spontaneous pneumothorax or the relatively acute onset of pneumonia, although the absence of fever, chills, or sputum production makes the latter diagnosis less likely. The patient was evaluated by his primary care provider and told that chest radiography revealed a dislocated rib but was otherwise normal. Over the course of the next four months, progressive exertional dyspnea developed; dyspnea then occurred when the patient was at rest and was accompanied by three-pillow orthopnea. I am uncertain what is meant by a “dislocated rib” and would explore the rib finding to confirm whether an abnormality is really present. Progressive dyspnea has become the predominant symptom, and its severity and progression are quite striking. Pulmonary disorders that might progress at this rate include pulmonary parenchymal disease (a broad spectrum, ranging from disseminated tumor to pulmonary alveolar proteinosis and Goodpasture’s syndrome), airway disease (e.g., asthma or obliterative bronchiolitis), or pulmonary vascular disease (e.g., primary pulmonary hypertension or occult thromboembolic disease). The presence of orthopnea raises the possibility of underlying cardiac disease associated with high left atrial pressure, as might be seen with mitral-valve disease or a cardiomyopathy." @default.
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- W155536303 date "2002-01-01" @default.
- W155536303 modified "2023-09-23" @default.
- W155536303 title "T HE U NUSUAL S USPECT" @default.
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