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Likelihood Ratio (LR) in Emergency Medicine

11/17/2012

Pleuritic Pain, the end of the saga...


video



Clinical Scenario

A 33 y/o woman, comes to the ED because of a sudden emithorax pain on the left in basal region. The pain is described as stabbing, well localized, it worsen with inspirium …a pleuritic pain, no cough, no fever, not hemoptysis. She smokes, she does not take any medication. 
Chest x ray is normal. You receive blood test: WBC 7.500/mcL, CRP 20 mg/dl , D-dimer 603 ng/ml

We have seen in the previous post that we can’t rule out the possibility to find a radio-occult lesion based on our blood test, but on the other hand specificity is poor, so what are we looking for?
What does pleuritic pain means? 
If you ask wikipedia… the answer is frightful…


What if you ask to your probe?







Conclusion 

Lung ultrasound is considered positive when direct scanning of the painful chest area shows at least one of the following: absence of sliding, B+ pattern, peripheral alveolar consolidation,  irregularity of the pleural line with or without effusion.
Sonographic examination can be limited to the painful thoracic area, thus requiring no more than 1 to 2 minutes. 
It has a very high sensitivity and specificity in detecting any pleural or pulmonary radio-occult condition manifesting as pleuritic pain. 



Bibliography

American Journal of Emergency Medicine (2012) 30, 317–324 
A comparison of different diagnostic tests in the bedside evaluation of pleuritic pain in the ED 
Giovanni Volpicelli M et al.



Ilenia Spallino

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