Peer Reviewed

Radiology Quiz

A 74-Year-Old With Chronic Chest Pain

Michael Grover, DO1 • Sethu Sandeep Koneru, MBBS2

    1Department of Family Medicine, Mayo Clinic, Scottsdale, AZ
    2Centinela Hospital Medical Center, Inglewood, CA

    Grover M, Koneru SS. A 74-year-old with chronic chest pain. Consultant. Published online March 2, 2023. doi:10.25270/con.2023.03.000002

    Received August 17, 2022. Accepted December 9, 2022.

    The authors report no relevant financial relationships.

    This manuscript was completed while Dr Koneru was working as a research associate in the Department of Family Medicine at Mayo Clinic in Scottsdale, AZ.

    Michael Grover, DO, Mayo Clinic Primary Care Center – Thunderbird, 13737 North 92nd Street, Scottsdale, AZ 85260 (

    Introduction. A 74-year-old man presented to the clinic complaining of chest pain. He described the pain as an intermittent discomfort, which was localized to the middle of the sternum without radiation.

    History. His past medical history was significant for hypertension, hyperlipidemia, inflammatory polyneuritis, atrial fibrillation with aspirin prophylaxis (after multiple incidents of hemorrhage on anticoagulants), and coronary artery disease. He had undergone coronary artery bypass grafting in 1995. While he had been feeling intermittent discomfort for years, the symptom frequency and severity had recently increased, prompting him to seek evaluation for it for the first time in our clinic.

    He graded the pain at times a 7 out of 10 on the Numerical Rating Scale. The pain worsened with turning or twisting his trunk, which was evident with examination. On palpation, a gap was felt in the lower third of his sternum. The x-ray of the chest is shown below (Figure 1).

     Picture 1

    Figure 1. Patient chest x-ray at presentation with reported chronic chest pain.

    Answer and discussion on next page. 


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