Case 4

A 27 yo male, of African descent, presents with a 2 day history of worsening chest pain. The pain is dull, severe, localized to the right chest and is non-radiating. Over the past number of hours, the pain has become associated with cough and shortness of breath.  

The patient has a history of sickle cell disease. He is not on any regular treatment. The patient denies any recent mild infectious illnesses, travel or sick contacts. Feels that pain started after a particularly hard training session.

On general examination the young man appears SOB and in acute pain.

HR 100

Sats 92%RA

RR 26

130/80

Temp 37.9

Question 1

What is the most likely diagnosis?

Question 2

What other differentials must be considered?

Question 3

What investigations would you order for this patient?

Question 4

What is the emergency treatment for this condition?