An 85 year old lady was admitted to hospital after experiencing an abrupt onset of right sided chest and mid thoracic back pain. This pain was exacerbated by movement and coughing but not by inspiration. There was no history of recent injury. Her past medical history included atrial fibrillation (AF), aortic stenosis, hypertension and chronic obstructive pulmonary disease. Medication on admission included bendrof lumethiazide 2.5mg od, digoxin 125 mcg od, doxazosin 4mg od, enalapril 20mg od, warfarin and salbutamol and seretide inhalers. Prior to the onset of the pain she had been independently mobile with a stick.
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