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Chest pain during military training: how unilateral pulmonary oedema masked an acute aortic dissection in a young service person
  1. Ben Watkins1,
  2. T Keady2 and
  3. R Hurwitz-Bremner1
  1. 1 Intensive Care Department, Frimley Park Hospital NHS Trust, Frimley, UK
  2. 2 Department of Anesthesia and Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
  1. Correspondence to Dr Ben Watkins, Intensive Care Department, Frimley Park Hospital NHS Trust, Frimley GU16 7UJ, UK; ben.watkins4{at}nhs.net

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A 26-year-old male service person with no medical history experienced ‘tightness’ across the lower chest and upper abdomen, which came on during a rigorous military physical training session. The pain was described as dull with some subtle radiation to the back. The discomfort was not severe enough to stop him from continuing the physical training although worsened afterwards throughout the day. He self-presented to the local emergency department (ED) later that evening.

The patient, a non-smoker who denied any recreational drug use, was not aware of his family history due to adoption. On admission, he was found to be hypertensive at 150/65 mm Hg, but otherwise, observations and examination were unremarkable with no audible murmurs.

White cell count (normal range 4.5–11.0×109/L) and C reactive protein (normal range <4 mg/L) were both elevated at 15.0×109/L and 17 mg/L, respectively, although all other routine blood tests were normal. ECG showed sinus …

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Footnotes

  • Contributors BW, TK and RH-B were all involved in the patient’s care during his hospital admission, contributed to planning discussions and and edited the manuscript. BW undertook the consent process and collected the patient’s data. BW and TK wrote the manuscript for this article. BW submitted the manuscript and is responsible for its overall content.

  • 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.