Sudden severe chest pain: an atypical presentation of an infective exacerbation of COPD

Abstract

Presentation

A 59-year-old female, recent ex smoker, with a history of COPD and anxiety, presents to her GP with acute onset sharp chest pain, associated with dyspnea, diaphoresis and palpitations. On examination tachycardia, tachypnea and rhonchi were noted in the absence of fever and crepitations.

Differential Diagnosis

Her presentation raises suspicion for several conditions that require urgent treatment, including AMI, PE and pneumothorax. Few indicators of infection were present initially.

Investigations

Given the risk of life-threatening conditions included in the differential diagnosis, hospital work-up was warranted. Investigations for AMI, PE, and pneumothorax were negative. Further investigations and development of the clinical course led to the conclusion of a diagnosis of IECOPD.

Conclusion

Presentations of IECOPD can be diagnostically difficult. Although pain
is not usual in IECOPD and pyrexia is common, this case illustrates the absence of such features in the presence of additional atypical features. Furthermore, acute chest pain often requires hospital investigation even if the ultimate diagnosis may be managed by the GP.