19 year male came with sudden chest pain that awakened him from sleep at 3 AM. The pain is located in the midsubsternal region and radiates to the neck. The patient describes it as a sharp pain. The pain worsens with inspiration and is associated with shortness of breath. The patient denies having any fevers, chills, cough, hemoptysis, nausea, or vomiting.The patient has an 8–pack-year history of smoking cigarettes. He denies any alcohol use. Chest radioghaphs are attached. Share your views on diagnosis and management.


X-ray chest is normal. It may be a case of gastric ulcer. Rule out IHD, go fir upper GI endoscopy & treat accordingly.

X-ray chest--? min.pneumomediastinum thin airstrip anteriorly behind sternum ---- maybe ruptured bulla Adv. CT thorax hrct If it is normal, gastritis/ peptic ulcer, GERD may be considered

Though cxr pa view looks essentially normal lateral show S evidence of a very small pneumo mediastinum . Rupture of small emphysrmatous bullae ,as he is a ch smoker, has to be ruled out before labeling as gerd . Get a Ct thorax before proceeding any further.

At 19 yrs of age, surprising to see 8 pack year h/o. Cxr is normal Most probably GERD. Treatment with PPI. Anyways, advice Ecg and PFT.

Along with lifestyle Modifications.


Differential diagnosis should be done between gastrointestinal diseases and cardiac problems. Although the patient is in his young ages for coronary artery disease if there is a history of family it shouldn't be underestimeted. ECG and troponin in acute settings can be done in the first line. And also the PPI response of the patient can also give a rough estmation on differential diagnosis.

GERD but ECG with 2decho to be on safer side

xray - normal.......might be gastritis or gastric ulcer

Pneumomediastinum Patient is a smoker , ? Rupture of Emphysematous bulla Suggest CT chest

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