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187502
I saw a patient yesterday, 32 y/o WM, yearly checkup, patient mentions focal right sternal border pain located at the 3rd intercostal space that has been persisting for 3 months. He described the pain as being "not sharp but not dull, feels like someone jabbing their thumb into my chest hard, usually aches for a few minutes afterward". He said it happens anywhere from 1-4 times a day. Patient denies body position, ingestion of food or beverage, time of day, or physical activity related to induction of pain.
The skin around the area he indicated showed no marks, swelling, or color change compared to the surrounding area. Palpation was uneventful. Lungs were clear, cardiac auscultation was uneventful, EKG was clear. History of pneumonia 15 years ago, yearly complaints of costochondritis during the winter but never in the spring/summer/fall. Patient denied recent illness, coughing, allergies, or heavy lifting. Pressure applied with the heel of the hand along the right sternal border elicited no response, patient denied any pain. Historical CXR taken after MVA in 2004 was uneventful, radiologists report read "clean chest".
My conclusion was either pyrosis (most likely) or persistent musculoskeletal inflammation (less likely), with either potentially being aggravated by external factors that the patient was unaware were contributory.
After I was done my resident sent me out to scut. When I was finished I asked him if he concurred with my findings and conclusion, he asked me to research the complaint/symptoms further and report back to him tomorrow with my conclusion, either confirming my original theory or not.
Looking through a number of resources I haven't found anything that would make me alter my original conclusion. Any suggestions on tests I should have suggested/ordered or other possible causes of the chief complain I might have missed?
The skin around the area he indicated showed no marks, swelling, or color change compared to the surrounding area. Palpation was uneventful. Lungs were clear, cardiac auscultation was uneventful, EKG was clear. History of pneumonia 15 years ago, yearly complaints of costochondritis during the winter but never in the spring/summer/fall. Patient denied recent illness, coughing, allergies, or heavy lifting. Pressure applied with the heel of the hand along the right sternal border elicited no response, patient denied any pain. Historical CXR taken after MVA in 2004 was uneventful, radiologists report read "clean chest".
My conclusion was either pyrosis (most likely) or persistent musculoskeletal inflammation (less likely), with either potentially being aggravated by external factors that the patient was unaware were contributory.
After I was done my resident sent me out to scut. When I was finished I asked him if he concurred with my findings and conclusion, he asked me to research the complaint/symptoms further and report back to him tomorrow with my conclusion, either confirming my original theory or not.
Looking through a number of resources I haven't found anything that would make me alter my original conclusion. Any suggestions on tests I should have suggested/ordered or other possible causes of the chief complain I might have missed?
