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Delayed Diagnosis Of Atypical Rib Pain In A College Athlete: A Case Report - Page #1
 

Author: Stacey Isidro, MD
Co Author #1: Rachel Chamberlain, MD
Senior Editor: Drew Duerson, MD
Editor: Marc Hilgers, MD, PhD, FAMSSM

Patient Presentation:
A 23-year-old male football player with no previous past medical history presented to the emergency room with two days of right lower rib pain after an intense workout.

History:
His mother had a history of a deep vein thrombosis. He had no sickle cell trait, recent trauma, surgery, prolonged travel, or history of coagulation disorders. The rib pain was characterized as 9/10 and worse with inspiration and upper body exercises. There was no relief with acetaminophen or ibuprofen. He left against medical advice in the emergency department. Three days later he presented to the training room with improving symptoms. The plan was to follow-up as needed. Two months later he returned with two days of left rib pain and shoulder pain after football practice that was worse than the previous episode. It was associated with pleuritic chest pain, dyspnea, and worse with lying supine. The plan was to return as needed. He returned the following day with worsening symptoms. There was no cough, palpitations, nausea, or dizziness.

Physical Exam:
During his initial evaluation, his vital signs were within normal range. There was no reproducible chest pain with palpation or range of motion. The cardiac and lung exams were normal. When he returned to the training room with worsening symptoms, he was noted to have a heart rate of 101, oxygen saturation of 90 percent on room air, and normal peak flows. He had non-labored respirations without wheezing on room air. There was no reproducible tenderness over the ribs and intercostal areas. The lung exam was normal. There was pain to the chest wall, medial left shoulder, and trapezius when he was supine.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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