A 45-year-old smoker patient presents with sudden onset unrelenting chest pain with loss of peripheral pulses. Lung fields are clear and has normal air entry. First differential diagnosis is?: (A) Mirizzi's syndrome, (B) Acute aoic syndrome, (C) Acute pericarditis, (D) Spontaneous pneumothorax
Answer is B. Acute Aoic Syndrome- Chest pain + loss of peripheral pulses Mirizzi's syndrome - Common hepatic duct obstruction caused by extrinsic compression from an impacted stone in cystic duct or infundibulum of gall bladdder. Acute pericarditis Diffuse chest pain at rest for hours - days Radiation to left shoulder (Phrenic nerve involvement) Relief: - on sitting Pericardial friction rub heard on auscultation Spontaneous pneumothorax Absent air entry. Hyper resonant lung. More blackening. Decreased breath sounds.