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- W2019429805 abstract "HISTORY: A 17 year old male, high-school student presented with acute onset of retrosternal upper chest and neck pain during inspiration. He also had sore throat and mild headache. Onset of symptoms was about 14 hours prior to presentation. He reported dyspnea and non-productive cough that had started on that same day. His mother had upper respiratory symptoms. He had a history of childhood asthma, but had no exacerbations since the age of 3. On direct questioning, he revealed he had been weight-lifting on the day prior to presentation. PHYSICAL EXAM: Not in respiratory distress, RR 18/min, SpO2 93% in room air, 97% on oxygen 2L/min. No tenderness or crepitus on palpation of neck or chest. Neck was supple. Pharynx and tonsils: no erythema or exudates. Cardiovascular exam was normal. Auscultation of lungs showed mild expiratory wheeze initially with equal air entry; subsequently most prominent finding was crackles noted in the precordium (Hamman sign). DIFFERENTIAL DIAGNOSIS: Pneumothorax Pneumomediastinum, subcutaneous emphysema Asthma exacerbation Pneumonia Cardiac ischemia Pulmonary embolus TEST AND RESULTS: CT soft tissue neck: Subcutaneous emphysema in the neck diffusely extending to superior mediastinum; interstitial air in upper lobes bilaterally, air within the epidural space of cervical and thoracic spine. Atlectasis on right apical lung field. CXR: No pneumothorax. Pneumomediastinum; gas in the neck soft tissues, more on the left than right. Normal heart size. Xray soft tissue neck: Gas within the neck soft tissues, more on the left than right, also seen in the prevertebral space on lateral view. No swelling visible, with otherwise normal appearance of the soft tissues. FINAL WORKING DIAGNOSIS: Pneumomediastinum, subcutaneous and interstitial emphysema, precipitated by weight-lifting TREATMENT AND OUTCOMES: 1.Observed inpatient for 24 hours during which he remained stable, and oxygen weaned off 2.He was started on empirical antibiotics which were discontinued once final diagnosis was known. 3.He was given inhalational albuterol treatments initially for wheezing, which cleared quickly 4.Pain management with acetaminophen, ibuprofen 5.Conservative management; air will be reabsorbed 6.No weight-lifting until symptoms had resolved" @default.
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- W2019429805 date "2009-05-01" @default.
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- W2019429805 title "Chest Pain And Neck Pain- Weight-lifting" @default.
- W2019429805 doi "https://doi.org/10.1249/01.mss.0000353980.62955.79" @default.
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