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  1. Nicolas Cazes1,
  2. Anaïs Briquet2,
  3. Aurélien Renard3
  1. 1 Emergency Medical Service, Bataillon de marins-pompiers de Marseille, Marseille, France
  2. 2 Pulmonology Department, Hôpital d’Instruction des Armées Laveran, Marseille, France
  3. 3 Emergency Department, Hôpital d’Instruction des Armées Sainte-Anne, Toulon, France
  1. Correspondence to Dr Nicolas Cazes, Emergency Medical Service, Bataillon de marins-pompiers de Marseille, Marseille 13003, France; md.ncazes{at}gmail.com

https://doi.org/10.1136/emermed-2018-207779

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    An 83-year-old woman was admitted to the ED because of right-side chest pain lasting for 2 hours. She had been treated for right pulmonary infection for 10 days and had experienced a paroxysmal atrial fibrillation discovered 4 days prior anticoagulated with apixaban. Clinical examination, vital signs and ECG were normal. The first hypersensitive troponin was negative. A CXR was performed in bed (figure 1).

    Figure 1

    CXR performed in bed.

    Question

    What is the diagnosis?

    1. Pulmonary embolism (PE)

    2. Pleuropneumopathy

    3. Aortic dissection complicated by haemorrhagic pleural effusion

    4. Acute coronary syndrome

    Answer: A

    A careful reading …

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    Footnotes

    • Contributors NC saw the patient in the ED. AB saw the patient in her pulmonology department. NC and AB made the diagnosis. NC wrote the manuscript in consultation with AR. AR translated the manuscript before professional proof-read.

    • Funding The authors have not given a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Patient consent for publication Obtained.