History of the Present Illness:

Mr--- is a previously healthy 52-year-old male who presents with a five-day history of shortness of breath, haemoptysis, and right-sided chest pain. He works as a taxi driver, and the symptoms began three days prior to admission while working. A day after the symptoms began, due to a worsening of his dyspnoea and pain, the patient decided to go to the local A&E. There, he was diagnosed with pneumonia and placed on Levaquin 500 mg daily and Benzonatate 200 mg TID, which he has been taking for two days with only slight improvement. He returned home and continued to experience shortness of breath, right-sided chest pain, and haemoptysis. He presented to an urgent care clinic earlier today, and was subsequently transferred to Redgrove ER due to the provider’s suspicion of PE.

The right-sided pain is located halfway down his ribcage, below the axilla. This pain is sharp, about 7/10 in severity, and worsens with movement and cough. Pressure on the chest does not recreate the pain. The haemoptysis has been unchanged since the onset, but the patient’s sputum has been consistently blood-tinged. The blood appears redder at night. The dyspnoea has been severe, and the patient has difficulty walking more than a few paces and reports a “rattling” feeling in his chest. At baseline, he experiences no dyspnoea on exertion and has no history of COPD or other respiratory problems. He is a smoker, and has smoked approximately a pack a day since the age of 17. Past history is notable for the fact that he experienced transient left lower leg swelling – from below the knee down – and pain several weeks ago during a long drive. He also notes a four-day history of decreased appetite, poor sleep, and subjective fever and chills. He had a bout of pneumonia about two months ago, but has been healthy for the most part and denies any chronic medical conditions. Currently he is fairly comfortable, with morphine helping with the pain. He has no history of a clotting disorder, no cardiac history, and denies any chest trauma or aspiration. He has had no sick contacts.