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The Sign Of Levine, But What Does It Mean? - Page #1
 

Author: Vikas Shahi, MD
Co Author #1: Kelly Estes, MD
Co Author #2: Richard Figler, MD
Senior Editor: Justin Mark Young, MD
Editor: Leigh Romero, MD, ATC, LAT

Patient Presentation:
A 15-year-old male offensive lineman presents to the training room after the completion of his high school football game complaining of chest pain.

History:
A 15-year-old male offensive lineman presented to the training room after the completion of his high school football game. At some point during the 3rd quarter, he recalled taking a helmet hit to his chest. He felt immediate chest pain, but he continued to play through the pain for the duration of the game, without making his coaches, athletic trainer, or sideline physician aware.

When he presented to the training room after the game, he was complaining of mid-sternal chest pain with a pleuritic component to the pain. He stated he was also having some difficulty breathing, mostly secondary to the pain. Despite the game ending about 15 minutes prior to his arrival to the training room, he stated that he was still sweating. He denied any nausea, vomiting, difficulty swallowing, positional features to his pain, or abdominal pain. He denied any past medical history, taking any medications, and family history of cardiac disorders.

Physical Exam:
Vital Signs: Manual Blood Pressure 130/90, Heart Rate 95 beats per minute, SpO2 94%, Respiratory Rate 15
General: Uncomfortable appearing male sitting on the examination table with positive Levine's Sign (clenched-fist over chest)
Skin: Diaphoresis was appreciated. No ecchymosis was appreciated over his chest wall.
Neck: No JVD.
Chest: Midsternal pain to palpation. No rib tenderness appreciated. Unremarkable heart auscultation.
Lungs: Bilateral breath sounds present; however, the patient was splinting and unable to inspire deeply due to pain. No crackles or wheezing was appreciated.
Abdomen: Abdomen was soft and without tenderness.
Back: No midline back or costovertebral angle tenderness was appreciated.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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