Author: Mark DeFord, MD
Editor: Benjamin Hasan, MD
Senior Editor: Kristine Karlson MD
Patient is a 50 year old male that presented with shortness of breath and chest pain after being hit in the left upper chest by another player's shoulder while trying to head a ball during a soccer game.
He stated that symptoms began immediately after he was hit. He had sharp, stabbing left upper chest pain rated at 6 out of 10 that increased with inspiration and coughing. He also complained of shortness of breath, abdominal cramping, nausea, and palpitations. He had a pertinent medical history of asthma, though he denied that his symptoms were similar to an asthma exacerbation. He denied any loss of consciousness or head injury.
On inspection, there was localized swelling and blanchable erythema in the left upper chest, just inferior to the clavicle, two to three inches lateral of the sternum. There was no subcutaneous emphysema or palpable deformity. The patient was tender over the 3rd and 4th ribs near left sternal border and mid-axillary line. He was tachypneic with a respiratory rate of 30 without obvious distress. There were clear and equal breath sounds in all lung fields and normal heart rate and rhythm without murmurs, rubs, or gallops.
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