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JAMA Surgery Clinical Challenge
October 2016

Chest Discomfort and Longstanding Dyspnea on Exertion

Author Affiliations
  • 1Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
JAMA Surg. 2016;151(10):979-980. doi:10.1001/jamasurg.2016.2043

A man in his early 40s was referred for surgical evaluation following abnormal imaging obtained during workup of recent left-sided chest discomfort and longstanding dyspnea on exertion. A large air-fluid level was seen on a recent chest roentgenogram, and subsequent computed tomographic scans of his chest were obtained (Figure 1). The only medical history reported was a previous umbilical hernia repair. On further discussion, it was discovered that he was involved in a motorcycle crash many years ago. Other than a brief loss of consciousness, no significant injuries were sustained per the patient’s report. He did undergo a formal trauma evaluation at that time; however, the radiographic images and medical records were no longer available. In addition to complaints of dyspnea and chest discomfort, the patient reported 5 to 6 episodes of small-volume emesis over the last 6 months. He denied any other gastrointestinal symptoms, such as heartburn, dyspnea, or constipation. The results of his examination were unremarkable, with the exception of bowel sounds being heard on auscultation of the left chest.

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