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The patient is a 17-year-old male who presents with a complaint of throat pain. He reports a history of colitis, for which he was treated with mesalamine and prednisone, 20 mg/day.

On exam, you discover that he is also experiencing pressure over his chest. Blood pressure is 97/60, pulse is 93, and SAT is 97%. He is afebrile. you find no abnormalities except for crepitations over his left shoulder soft tissue.

View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: April, 2009

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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