Chest Pain In A Soccer Player

HISTORY: A 20-year-old profession striker presented to the sideline with acute chest pain after chest trapping a punt. The goalkeeper placed a well struck ball that the striker deflected down. He immediately ran off the field and sat down leaning forward. He did also complain shortness of breath. PHYSICAL EXAMINATION: Examination on the sidelines revealed normal chest wall expansion. No chest wall tenderness. Normal rhythm. Heart sounds revealed no murmurs, rubs or gallops. Breath sounds were clear to auscultation and symmetric. Symptoms were worsened with lying down and improved with leaning forward. DIFFERENTIAL DIAGNOSIS: 1. Pulmonary contusion 2. Cardiac contusion 3. Rib fracture TEST AND RESULTS: Sideline ECG- — Bradycardia 50 bpm, otherwise normal for an athlete hs trop- 38, 62 ( <20 ng/L)TTE- LVEF 56%. No segmental wall motion abnormalities.Cardiac MRI- Mid septal edema FINAL/WORKING DIAGNOSIS: Cardiac ContusionTREATMENT AND OUTCOMES: 1. No exercise for 1 week and 7 day Holter. 2. Repeat MRI at 2 weeks showed resolution of septal edema4. Patient began a graded return to play over 5 days. 5. Returned to sports 3 weeks post injury.