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Pain in abdomen and shoulder

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While the patient complained of pain, he didn’t mention any breathing problems. That was surprising, given his x-ray.


 

References

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series

A 26-YEAR-OLD MAN came into the emergency department for treatment of vomiting, and pain in his abdomen and right shoulder. His vital signs were normal, with the exception of his heart rate, which was 109 bpm. His oxygen saturation was 96% on room air. The patient, a smoker, did not complain of any difficulty breathing, despite having diminished breath sounds over the left lung fields and absent breath sounds over the right. The rest of the exam was normal.

The patient’s initial blood work was within normal limits. We ordered a chest x-ray (FIGURE 1) and a chest computed tomography (CT) scan to further assess his decreased breath sounds.

FIGURE 1
A revealing X-ray

A 26-year-old man sought care for pain in his abdomen and right shoulder. His x-ray revealed a massive right-sided pleural effusion resulting in a hemothorax and partial collapse of the left lung.

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU MANAGE THIS CONDITION?

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