0
JAMA Clinical Challenge |

Episodic Abdominal and Chest Pain in a Young Adult

Marcello Migliore, MD, PhD; Maria Signorelli, MD, PhD
JAMA. 2012;307(16):1746-1747. doi:10.1001/jama.2012.506.
Text Size: A A A
Published online

Extract

A 22-year-old man has experienced intermittent severe chest and abdominal pain for a year. He stopped playing water polo because of recurrent severe abdominal pain in his right and left upper quadrant. He was evaluated for suspected pancreatitis, but all diagnostic results were unremarkable. A few weeks later he was admitted for acute chest pain, and again all diagnostic results were unremarkable. In 1 year the patient had 7 hospital admissions for abdominal or chest pain with no episodes of fever, chills, sweats, or cough. There is no history of trauma. The patient is currently treated with ketoprofen, oral morphine, and anxiolytic drugs. He spends almost all day in bed but is unable to sleep in a prone position and has pain in his throat. He has taken a leave of absence from college and reduced his social activities. The patient has received injections of cortisone and ketoprofen in the xiphoid area administered 10 days apart; however, pain persists. Physical examination is remarkable for considerable pain over the xiphoid on palpation. Slight pain is elicited on examination of the right second and third sternocostal cartilages. Chest computed tomography (CT) has been performed several times with interpretations ranging from osteochondritis to xiphoid fracture (Figure 1).

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 6

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination
Evidence Summary and Review 1

The Rational Clinical Examination
Evidence Summary and Review 2

brightcove.createExperiences();