Investigating severe interscapular pain

doi:10.1136/bmj.a688

Published 21 July 2008, doi:10.1136/bmj.a688
Cite this as: BMJ 2008;337:a688

Practice

Rational Imaging

Investigating severe interscapular pain

Ali A Haydar, radiologist¹, Gareth Morgan-Hughes, cardiologist², Carl Roobottom, radiologist¹

¹ Peninsula Radiology Academy, Plymouth PL6 5WR, ² Cardiology Department, Derriford Hospital, Plymouth

Correspondence to: A Haydar drahaydar@hotmail.com

This article explores the radiological investigations for identifyingthe cause of severe interscapular pain, focusing on how to excludeacute myocardial infarction, aortic dissection, and pulmonaryembolism

The first 150 words of the full text of this article appear below.

A 52 year old woman presented with a sudden onset (two hourhistory) of severe interscapular burning pain associated withshortness of breath. Her medical history was unremarkable exceptfor a strong family history of coronary heart disease.

Examination was normal apart from a blood pressure of 150/80mm Hg and heart rate of 110 beats/min. The respiratory ratewas 14 breaths/min, and the patient was afebrile with otherwisenormal cardiorespiratory examination. Chest radiography showedborderline widened mediastinum and upper lobe venous congestion.Electrocardiography showed non-specific changes in the T waves.Blood gas analysis showed the patient to be hypoxic (PaO₂ =8 kPa (normal 8-14 kPa)), with no evidence of carbon dioxideretention. Her full blood count and biochemical profile werenormal except for mildly raised C reactive protein and positiveD-dimers. Baseline level of troponin I was <0.01 ng/ml.

Chest pain was partially relieved by glyceril trinitrate spray;. . . [Full text of this article]

What are the next investigations?

Serial electrocardiography and 12 hour troponin I testing
Echocardiography
Electrocardiogram gated multidetector computed tomography
Myocardial perfusion imaging