Correct!
2. Chest CT
Chest CT is probably the next most appropriate test to obtain among the choices listed. The troponin and electrocardiogram results make myocardial infarction unlikely in this patient. Pulmonary embolism is also unlikely given the lack of shortness of breath, the relatively good room air oxygenation, and the negative d-dimer results. An acute aortic syndrome remains a possibility, as does pericarditis, and even pneumonia, while less likely given the relatively normal appearance of the frontal, portable, chest radiograph, remains a consideration, and all of these diagnoses can be readily visualized at chest CT. Both thoracic MRA and echocardiography would prove useful for the assessment of pericarditis and are also useful tests for acute aortic syndromes, although chest CT is preferred for the latter.
Chest CT was ordered. The patient was awake and alert, still complaining of severe chest and epigastric pain, and further questioning was performed while awaiting chest CT. The patient admitted to recent upper gastrointestinal illness which was accompanied by significant nausea and vomiting. The patient had not vomited since his arrival in the emergency room, but did undergo severe retching with his vomiting prior to the development of his chest pain and calling for the ambulance.
Which of the following represents a new important differential diagnostic consideration for this patient’s presentation? (Click on the correct answer to proceed to the sixth of nine pages)