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Row, Row, Row Your Boat, Gently Down The [blood] Stream - Page #1
 

Author: Jaclyn McKenna, MD
Senior Editor: Heather Rainey, MD
Editor: Bernadette Pendergraph, MD

Patient Presentation:
22-year-old male collegiate rower presented with fever and right sternal chest pain.

History:
22-year-old male collegiate rower presented to the hospital with four days of worsening chest pain and two days of fever. The pain localized to his right sternal region. He described the pain as constant, sharp, and worsened with neck rotation. He noted a "clicking or popping" sensation in the same area for several years, but it was never painful before. He had self-lanced a blister on his left hand one week prior that drained "pus".

Physical Exam:
Temperature 103.2F, Pulse 105, Blood pressure 131/60, Respiratory rate 18, Oxygen saturation 99% on room air

General: An ill-appearing adult male with an athletic build.
Chest: He had marked tenderness at the right superior aspect of the sternum and right sternoclavicular joint. He had no overlying skin changes. He had no palpable swelling or bony abnormality.
Cardiovascular: He was tachycardic with a regular rhythm and no murmur.
Pulmonary: His lungs were clear to auscultation.
Abdomen: His abdomen was soft and nontender.
Extremities: He had callus formation on bilateral palms and fingers. He had a well-healed blister present over his left 5th metacarpopharyngeal joint without drainage or surrounding erythema.

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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