Abstract
Chest pain in low risk patients is a common ED presentation. Rarely, these patients
can have life-threatening conditions requiring timely diagnosis and intervention.
There are currently standardized protocols for diagnosing cardiac ischemia, pulmonary
embolus, and aortic dissection in low risk patients. Even more rare entities such
as esophageal perforation, hemo/pneumothorax, and cardiac tamponade must also be kept
in mind. We present the case of chest pain in a 33 year old male reporting no significant
past medical history who developed spontaneous massive hemothorax while being evaluated
in the ED. Subsequent investigation revealed that the patient had neurofibromatosis;
the etiology of aneurysmal rupture in neurofibromatosis is discussed.
Keywords
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References
- The health care burden of acute chest pain.Heart. 2005; 91: 229-230https://doi.org/10.1136/hrt.2003.027599
- Pitfalls in evaluating the low-risk chest pain patient.Emerg Med Clin North Am. 2010; 28: 183-201https://doi.org/10.1016/j.emc.2009.10.002
- National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary.Natl Health Stat Rep. 2006; 6: 1-38https://doi.org/10.1073/pnas.012540799
- Characteristics and outcomes of young adults who present to the emergency department with chest pain.Acad Emerg Med. 2001; 8: 703-708https://doi.org/10.1111/j.1553-2712.2001.tb00188.x
- Young patients with chest pain: 1-year outcomes.Am J Emerg Med. 2011; 29: 265-270https://doi.org/10.1016/j.ajem.2009.09.031
- Sudden death from cardiac causes in children and young adults.N Engl J Med. 1996; 334: 1039-1044https://doi.org/10.1056/NEJM199604183341607
- Evaluation of chest pain in the pediatric patient.Med Clin North Am. 2010; 94: 327-347https://doi.org/10.1016/j.mcna.2010.01.004
- Serial changes in highly sensitive troponin I assay and early diagnosis of myocardial infarction.JAMA. 2011; 306: 2684-2693https://doi.org/10.1001/jama.2011.1896
- Validation and impact of a simplified clinical decision rule for diagnosing pulmonary embolism in primary care: design of the PECAN prospective diagnostic cohort management study.BMJ Open. 2019; 9e031639https://doi.org/10.1136/bmjopen-2019-031639
- Aortic dissection in a 19 year old male without risk factors, case report and selective review of the literature.Am J Emerg Med. 2019; 1675: 1-3https://doi.org/10.1016/j.ajem.2019.10.007
- Esophageal perforation: a continuing challenge.Ann Thorac Surg. 1992; 53: 534-543https://doi.org/10.1016/0003-4975(92)90294-E
- Pericardial effusion impending tamponade: a look beyond Beck’s triad.Am J Emerg Med. 2009; 27: 216-219https://doi.org/10.1016/j.ajem.2008.01.056
- Hemothorax: etiology, diagnosis, and management.Thorac Surg Clin. 2013; 23: 89-96https://doi.org/10.1016/j.thorsurg.2012.10.003
- Non-traumatic and spontaneous hemothorax in the setting of forensic medical examination: a systematic literature survey.Forensic Sci Int. 2014; 236: 22-29https://doi.org/10.1016/j.forsciint.2013.12.013
- Spontaneous hemothorax: a comprehensive review.Chest. 2008; 134: 1056-1065https://doi.org/10.1378/chest.08-0725
- Endovascular therapy for subclavian artery rupture in von Recklinghausen disease.Vasc Endovascular Surg. 2010; 44: 714-717https://doi.org/10.1177/1538574410373836
- Neurofibromatosis: past, present, and future.N Engl J Med. 1991; 324: 1283-1285https://doi.org/10.1056/NEJM199105023241812
- Spontaneous hemothorax in a patient with neurofibromatosis type 1 and undiagnosed pheochromocytoma.Ann Thorac Surg. 2007; 84: 1021-1023https://doi.org/10.1016/j.athoracsur.2007.04.024
- Spontaneous hemothorax and neurofibromatosis: a review of a lethal combination.Asian Cardiovasc Thorac Ann. 2007; 15: 342-344https://doi.org/10.1177/021849230701500417
- Spontaneous hemothorax associated with von Recklinghausen’s disease.Eur J Cardio-Thoracic Surg. 2003; 23: 1062-1064https://doi.org/10.1016/S1010-7940(03)00145-3
- Spontaneous hemothorax caused by a ruptured intercostal artery aneurysm in von Recklinghausen’s neurofibromatosis.. 2005; 104: 286-289
- Ruptured aneurysm of the subclavian artery in a patient with von Recklinghausen’s disease.Circ J. 2005; 69 ([doi:JST.JSTAGE/circj/69.503 [pii]): 503-506
- Massive spontaneous hemothorax associated with Von Recklinghausen’s disease.Ann Thorac Surg. 2006; 82: 1500-1501https://doi.org/10.1016/j.athoracsur.2006.02.010
- Rupture of an intercostal artery in a patient with neurofibromatosis type 1.Interact Cardiovasc Thorac Surg. 2010; 10: 128-130https://doi.org/10.1510/icvts.2009.222125
- Spontaneous hemothorax in patients with von Recklinghausen’s disease.Japanese J Thorac Cardiovasc Surg. 2005; 53: 649-652https://doi.org/10.1007/BF02665078
- Spontaneous Hemothorax.JACEP. 1979; 8: 235-237
Article Info
Publication History
Published online: May 07, 2020
Accepted:
May 1,
2020
Received:
April 25,
2020
Identification
Copyright
© 2020 Published by Elsevier Inc.