Clinical Case 071: Chest pain puzzle

OK a quick case for you – a diagnostic case for you to ponder.  No critical care this week!

36 yo man presents to the GP with a 3 day history of increasing, sharp, pleuritic posterior chest pain that has a clear mechanical history.   It began the morning after a long play session in he pool with his kids throwing them up in the air / twisting and lifting.

Pain is localised over the T6 – 7 level, just lateral to the spinous processes.

Chest is clear, no cough, URTI sxs or signs, feels well aside from pain which is making breathing unpleasant.

On examination there is tenderness to the area described above. Range of movement is markedly reduced – limited by pain on lateral and forward flexion.  Rotational movement of the spine is limited by pain right more than left.

So here are the questions:

Q1:  What is the diagnosis most probably?

Q2:  What investigations would you do?

Q3:  Which medicines or other therapies would you advise / prescribe?

 

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