College Basketball Player With Dyspnea - Page #1

Author: Meggan Grant, DO
Co Author #1: Andrew Porter, DO
Co Author #2: Richard Leu, MD
Co Author #3: Mark Stovak, MD

Patient Presentation:
A 20 year old African-American women's collegiate basketball player presents to training room during preseason workouts complaining of dyspnea, mid-line chest pain and left sided rib pain. She recalls no mechanism of injury. She denies cough, fever, chills or abdominal symptoms. She denies leg pain, cramping or swelling. Her chest pain is decreased when leaning forward. She has a history of asthma, which was well controlled until the 5 days prior to presentation when she began having shortness of air, substernal chest pain and left posterior lateral rib pain. Recent travel included a basketball trip to Europe one month prior to developing symptoms.

She went to the student health clinic and was treated for asthma exacerbation with nebulized albuterol and was given non steroidal antiinflammatory medication for costochondritis. She experienced mild improvement of symptoms with albuterol but pain continued and was worse with activity, deep inspiration and laying supine. Past medical and surgical history: ADHD, Asthma, negative sickle cell testing. Family history: adopted. Social history: Denies tobacco, alcohol or drug use. Allergies: no known drug allergies. Medications: Yasmin 1 tab po daily, Adderall 20 mg po daily, Albuterol inhaler PRN. Review of Systoms: negative except for what was mentioned in the history of present illness.

Physical Exam:
Afebrile, BP 104/58, Pulse at rest 85, pulse with ambulation 120. Sa02 100% at rest and ambulation.
General: Alert and oriented, mild distress
HEENT: Normal
Neck: Supple, no lymphadenopathy or enlarged thyroid
Respiratory: Splinting and shallow breaths, decreased breath sounds in left lower lobe, otherwise clear to asculatation without wheezes, crackles, or ronchi. No pleural friction rub. No cough.
Cardio: Regular rhythm, slightly tachycardic without murmur, rub or gallop
Abdomen: no CVA tenderness, no bruits, bowel sounds positive, nontender, nondistended.
Musculoskeletal: Guarding of the left abdominal musculature, and spasm of the left quadratus lumborum and intercostal muscles of ribs 8-12. Tenderness over the left lower rib cage anteriorly and posteriorly.
Derm: no skin changes
Extremities: Dorsal pedal and posterior tibial pulses 2+. Lower extremities without any edema, tenderness or erythema. Homan's negative, Thompson's negative.

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