Pleuritic Chest Pain and Hypoxia

🗒️ Question

A 68 year old man presents with sudden onset shortness of breath and sharp chest pain that worsens with deep inspiration. He has a history of COPD and was recently hospitalised for pneumonia. He does not take anticoagulants and has no history of thrombosis.

On examination, his blood pressure is 102/65 mmHg, heart rate is 115 bpm, respiratory rate is 28 and oxygen saturation is 88% on air. He has mild swelling in the right calf with tenderness over the calf muscle.

Investigations:

• D-dimer: 2.2 µg/mL (<0.5 µg/mL)

• ECG: sinus tachycardia

What is the most likely diagnosis?

(A) Acute coronary syndrome

(B) Aortic dissection

(C) Community acquired pneumonia

(D) Pulmonary embolism

(E) Pneumothorax