Question

A 25-year-old man presents with acute onset shortness of breath associated with right-sided chest pain. The pain is unaffected by position and is worse with inspiration. He was grocery shopping when it started. He denies chest trauma. He had an upper respiratory infection earlier in the month that had resolved without incident. He smokes 1 pack of cigarettes per day, and he has no significant past medical history. On examination, he is afebrile and BP is138/80 mm Hg; pulse is 124, respiratory rate is 24, and pulse oximetry is 94% on room air with mild respiratory distress. Trachea is midline. He has increased resonance to percussion with no breath sounds on the right anterior apex; the other lung fields are clear to auscultation. Heart is tachycardic with normal S1 and S2; no murmur, rubs, or gallops are present.

What is the imaging of choice to make the diagnosis?

Chest computed tomography (CT)
2 Chest radiograph
3. Chest ultrasound
4 Electrocardiogram (ECG)
5 Spiral chest computed tomography (CT)

Answer 1

A chest radiograph is the initial imaging of choice to diagnose the cause of a patient's acute shortness of breath and chest pain.

Step-by-step explanation:

The imaging of choice to make the diagnosis for a 25-year-old man presenting with acute onset of shortness of breath and right-sided chest pain that is worse with inspiration is a chest radiograph. Given the clinical signs of increased resonance to percussion, absence of breath sounds on the right anterior apex, and a presentation that is not suggestive of an electrocardiogram (ECG) finding, a chest radiograph is the most appropriate initial imaging modality to assess for potential pathologies such as pneumothorax or pleural effusion that may present with these symptoms. A CT scan might be considered following the radiograph if further details are needed or if the radiograph is inconclusive. However, based on the given scenario, the most essential and immediate imaging to perform is a chest radiograph.