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Woman with cough and chest pain
  1. Chun-Jen Wu,
  2. Jen-Tang Sun,
  3. Chih-Jung Chang
  1. Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
  1. Correspondence to Dr Chih-Jung Chang, Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; chihjung0729{at}

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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.

Figure 1

Posteroanterior chest radiography gives a clue to further investigation.


What is the most likely diagnosis?

  1. Massive pulmonary embolism

  2. Aortic …

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  • Contributors C-JW acquired the clinical data, drafted the manuscript and maintained contact and consent with the patient. J-TS served as the scientific advisor and did revision of the manuscript. C-JC was responsible for editing the article and gave final approval to the manuscript.

  • Funding The authors have not declared 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.