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From Weight Room To Operating Room: Unraveling Exertional Chest Pain And Arm Swelling - Page #1
 

Author: Kyle Scheer, OMS-IV
Co Author #1: David Liddle, MD, FACP, FAMSSM
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Shayne Fehr, MD

Patient Presentation:
Chest Pain and Arm Swelling

History:
A 24-year-old Division-1 male collegiate football player presented to the training room with chest pain and arm swelling. He had a one-month history of progressive malaise, weakness, fatigue, shortness of breath, and chest discomfort. He denied cough or upper respiratory symptoms. He reported recent night sweats, intermittent headaches, and worsening exertional chest pain. Ten days prior to evaluation, he developed new-onset right upper extremity swelling, worsened with weight lifting; his symptoms improved during spring break with cessation of strength training. Upon resuming workouts, he developed left posterior chest wall pain, aggravated by deep inspiration. Over the past several weeks, headaches and fatigue had progressed with new-onset dizziness.

Physical Exam:
Vital Signs: BP 164/100, HR 87 bpm, RR 17, O2 92 % on RA
General: Fatigued but not ill; afebrile.
HEENT: Tender lymph nodes in the anterior cervical and submandibular chains. Oropharynx without exudate. No jugular venous distension.
Lungs: Clear to auscultation bilaterally with increased work of breathing.
Heart: Regular rate and rhythm with no murmurs, gallops, or rubs. 2+ radial pulses bilaterally.
Abdomen: Soft, non-tender. No renal bruit.
Extremities: Right upper extremity edematous with venous engorgement and greater than 2cm asymmetric circumference compared to the left side. Tenderness to palpation in the right infraclavicular region.

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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