Anesth Pain Med.  2023 Jan;18(1):65-69. 10.17085/apm.22182.

Ultrasound diagnosis and treatment of intractable anterior chest pain from golf - A case report –

• Park J
• Kim SJ
• Kim H
• Jung H
• Shin HY

• KMID: 2540336
• DOI: http://doi.org/10.17085/apm.22182

Abstract

Background
Pleurisy is an inflammation of the parietal pleura and is characterized by pleuritic pain. The most common cause of pleurisy is infection; other causes include rheumatoidarthritis, malignancy, rib fractures, or trauma. Possible causes of chest pain associated withgolf include costochondritis, stress fractures of the ribs, intercostal muscle strain, or, rarely,Tietze’s syndrome and slipping rib syndrome.Case: A 64-year-old female presented with intractable chest pain that began 4 months priorwhile playing golf. No specific cause was found after various examinations. There was persistent pain despite medical treatment. Ultrasonography (US) was performed over the painful areas, which revealed focal pleural effusions. A mixture of ropivacaine and triamcinolonewas injected into the focal pleural effusions using US guidance, which dramatically relievedher pain.Conclusions: This case demonstrates that US can be used as a diagnostic and therapeuticmodality for intractable chest pain with an undetected pathology.

Keyword

Chest pain; Golf; Pleural effusion; Pleurisy; Ultrasonography

Figure

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  Fig. 1. (A) High-resolution computed tomography image of the chest, which was initially read as normal, but upon reexamination, was found to show focal pleural effusion (white arrow), (B) Magnified view of the left anterior chest showing focal pleural effusion (white arrow).

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  Fig. 2. An ultrasonographic image of the focal pleural effusion asterisk (*). A long axis view of the anterior intercostal space at T5–6 with 4–18 MHz linear transducer (EPIQ 5, Philips, USA).

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  Fig. 3. An image of the ultrasound-guided intralesional injection. The white arrowhead indicates the needle. A long axis view of the anterior intercostal space at T5–6 with a 4–18 MHz linear transducer (EPIQ 5, Philips, USA). (A) Confirming the focal pleural effusion, a 23-gauge 5 cm needle was inserted using the in-plane technique from the lateral to the medial side of the left anterior chest at a point about 1 cm from the probe. (B) Intralesional injection was administered.

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