Woman with cough and chest pain

Clinical Introduction An otherwise healthy 50-year-old woman presented to the ED with cough and intermittent low-grade fever for a couple of days. She also had mid-chest and upper back discomfort while coughing. She had received acupuncture a few weeks prior to this episode. On arrival, her vital signs were stable and physical examinations were unremarkable. Laboratory results showed leucocytosis (white cell: 19.97x109/L cells/μL) with a leftward shift (neutrophils: 81%). Chest radiography was obtained (figure 1) and gave the clue to advanced imaging. Question What is the most likely diagnosis? Massive pulmonary embolism Aortic dissection Extramedullary haematopoiesis Paraspinal abscess Answer: D Left paraspinal stripe is a mediastinal interface between the left lung and the paraspinous soft tissues that runs smoothly from the aortic arch to the diaphragm. Normally, the left paraspinal soft tissues are very thin and can only...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research