Differentials
Acute coronary syndrome
SIGNS / SYMPTOMS
Chest pain is typically central and crushing.
There may be a history of prior exertional chest pain.
INVESTIGATIONS
ECG and troponin T may indicate myocardial infarction or ischemia.
ST segment depression may occur in acute dissection, but ST elevation is rare.
Pericarditis
SIGNS / SYMPTOMS
Chest pain typically pleuritic.
INVESTIGATIONS
ECG typically shows diffuse ST elevation.
Aortic aneurysm
SIGNS / SYMPTOMS
Stable (nondissecting and nonleaking) aneurysms are asymptomatic. Diagnosis is usually incidental to workup for another entity.
INVESTIGATIONS
Computed tomography angiography of the chest does not show dissection.
Musculoskeletal pain
SIGNS / SYMPTOMS
Pain may be reproducible on palpation of the affected area.
INVESTIGATIONS
Computed tomography angiography of the chest does not show dissection.
Pulmonary embolus
SIGNS / SYMPTOMS
Dyspnea, hypoxia, and pleuritic chest pain.
There may be evidence of deep vein thrombosis: for example, calf swelling or tenderness.
INVESTIGATIONS
Computed tomography angiography of the chest shows pulmonary embolus.
Mediastinal tumor
SIGNS / SYMPTOMS
Possible cough or hemoptysis.
INVESTIGATIONS
Computed tomography angiography of the chest shows evidence of tumor.
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