What is a likely diagnosis for a patient with severe right-side chest pain, shortness of breath, and a history of recent ankle fracture?

• A. Pneumonia
• B. Pulmonary thromboembolism
• C. Aortic dissection
• D. Myocardial infarction

Answer: (B)

The symptoms described—severe right-side chest pain, shortness of breath, and a recent history of ankle fracture—are highly indicative of pulmonary thromboembolism, particularly considering the context of the recent fracture. Deep vein thrombosis (DVT) can occur after immobilization or surgery related to fractures, leading to the development of clots that can dislodge and travel to the pulmonary arteries, resulting in a pulmonary embolism.

The acute onset of chest pain and dyspnea is typical of pulmonary thromboembolism, as it can cause significant respiratory distress and pleuritic pain due to the blockage of blood flow in the lungs. The fact that this patient has had recent lower limb immobilization following an ankle fracture further increases the likelihood of DVT and subsequent pulmonary embolism.

In contrast to this diagnosis, pneumonia would typically present with symptoms such as cough, fever, and sputum production, while aortic dissection often involves severe, tearing chest pain that may migrate to the back, accompanied by other neurological deficits or pulsatile differences on examination. Myocardial infarction usually presents with central chest pain, sometimes radiating to the left arm or jaw, along with potential risk factors like prior cardiovascular disease. Given the specific combination of