Sam is a 38-year-old office manager who presents to ED with a one-hour history of left-sided sharp pleuritic chest pain. He denies shortness of breath, cough, palpitations or other cardiac symptoms. Systems review is otherwise unremarkable.

Sam has a past medical history of depression, childhood asthma and provoked DVT following a trimalleolar fracture and open reduction internal fixation three years ago. He takes no regular medications, is an ex-smoker with a five pack-year history and infrequently drinks alcohol. Sam has no significant family history and lives at home with his wife and two children.