Sam is a 38-year-old office manager who presents to ED with a one-hour history of left-sided sharp pleuritic chest pain. He denies shortness of breath, cough, palpitations or other cardiac symptoms. Systems review is otherwise unremarkable.

Sam has a past medical history of depression, childhood asthma and provoked DVT following a trimalleolar fracture and open reduction internal fixation three years ago. He takes no regular medications, is an ex-smoker with a five pack-year history and infrequently drinks alcohol. Sam has no significant family history and lives at home with his wife and two children.

Initial assessment

Sam appears healthy and comfortable with no increased work of breathing. His vital signs are within normal limits. Heart sounds are dual with no murmurs and auscultation of the chest is clear. Pain is not reproducible on palpation.