Misleading Chest Pain

Chest pain is a common complaint in a patient presents to the emergency department(ED) and it caused by several life threatening conditions such as esophageal perforation. A 78 years old man known case of ischemic heart disease came into the ED with complaint of chest pain, physical examinations were normal on arrival. Electrocardiogram and chest x ray were no specific. Eventually he was admitted in CCU with acute coronary syndrome. During admission the patient got fever and productive cough. Despite antibiotic administration, patient was deteriorated and in this stage chest CT scan showed pulmonary abscess. Having no results in spite of utilizing board spectrum antibiotic, abscess drainage under guide of sonography was performed. A large amount of pus and food particle was drainage. Gasterographin study indicated esophageal perforation and entrance of contrast to mediastan and right sided pleura. With chronic perforation he was admitted in intensive care unit (ICU) with conservative management. After two weeks, the patient was discharged from hospital with good recovery and acceptable outcome. Chest pain is a common complaint in the emergency visits. Perhaps putting wrong the first step, begin a series of measures to be unnecessary in patients and delay the correct diagnosis. Esophageal perforation is a life-threatening condition that must be identified and treated early to minimize morbidity and mortality.