Chest Pain - Soccer

HISTORY: 18 year old male presents to the emergency department complaining of worsening continuous substernal non radiating pleuritic chest pain for 5 days and now experiencing mild shortness of breath. He first noticed the chest pain while playing recreational soccer with his club team last week and reported several elbows to the chest and a mechanical fall while on defense. He denies fevers, chills, back pain, nausea/vomiting, abdominal pain, weakness or paresthesias. However reports that he had nasal congestion, rhinorrhea and dry cough 2 weeks earlier. He has no significant past medical history and no known history of sudden death in his family. He occasionally smokes marijuana. He Denies alcohol, cocaine or other drug use. PHYSICAL EXAMINATION: Examination in the emergency department appreciated mild tenderness over the anterior chest wall. Normal S1/S2 without murmurs, rubs or gallops, equal and clear breath sounds bilaterally, palpable and equal radial and posterior tibial pulses. Abdomen soft-nontender and no focal neurological deficits. DIFFERENTIAL DIAGNOSIS:Pneumothorax, Pneumonia, Acute coronary syndrome, Pericardial effusion, Aortic dissection, Rib fracture, Costochondritis, Pericarditis/Myocarditis, Pulmonary embolism TEST AND RESULTS:EKG- Inferior and lateral ST elevations with anterior ST depressions Labs- Troponin: 0.688- Pro BNP: 500- Procalcitonin: 0.21- CRP: 41.4- WBC: 12Chest anterior-posterior radiograph:- Unremarkable lungs. Unremarkable pleural space. No pleural effusions or pneumothorax. No cardiomegaly. No acute rib fractures Point of Care Cardiac Ultrasound - Small pericardial effusion- Abnormal, hypokinetic cardiac base squeeze- Normal Ejection fraction and aortic root. No right heart strain FINAL WORKING DIAGNOSIS:Pericarditis TREATMENT AND OUTCOMES: Aspirin or NSAIDS for 7 to 10 days, followed by a 4 week taper. Colchicine for 3 months.Glucocorticoid therapy is considered if NSAIDs are contraindicated or if symptoms persist despite treatment. Patient was admitted to the medicine floor where he began NSAID and colchicine therapy and obtained formal echo. Patient was discharged 2 days later with appropriate cardiac follow up and advised to refrain from competitive sports for 1 to 3 months, during the acute phase of pericarditis.