CAUSES OF PLEURITIC CHEST PAIN

CAUSES HISTORY EXAMINATION INVESTIGATION
Pneumothorax Sudden onset.  May be related to trauma.   Associated with dyspnea.  History of COAD/Asthma Thin, asthenic build.  Tachypnea.   Unilateral decreased air entry with increased percussion note CXR - decreased peripheral lung markings
Pneumonia Associated with fever, cough, sputum and dyspnea.  Fever, tachypnea.  Focal decrease in air entry with bronchial breathing, dull percussion note and increased vocal resonance CXR - focal opacity
Pulmonary Embolism Sudden onset chest pain with dyspnoea or haemoptysis.

Risk factors for DVT e.g. recent surgery, bed rest, previous DVT/PE, maligancy

Often normal.  Tachypnoea.   Tachycardia ECG - sinus tachycardia, atrial fibrillation, 'S1Q3T3', dominant R in V1, RBBB

ABG - hypoxia or wide A-a gradient

CXR - usually normal

V/Q scan - V/Q mismatching

CT chest - perfusion defects

Acute pericarditis Young patients.  Pain relieved by sitting forward.  History of viral illness Usually normal. ECG - diffuse saddle shaped ST segments, PR depression