Diagnostic Considerations in Chest Wall Tenderness

To the Editor.  —In the October Archives, Dreyfuss and Weiland¹ described two patients with excruciating chest wall tenderness accompanying pulmonary embolism. Several statements in that article deserve comment.The authors said, "We were unable to find additional documented cases." Later, they said that severe chest wall tenderness dominating the clinical presentation of pulmonary embolism is "a finding not previously reported, to our knowledge." In 1942, however, McMillan² mentioned 18 patients who had "the most extreme tenderness" over areas of suspected pulmonary infarction. Autopsy in one of the cases demonstrated an infarct of the lung. At least four subsequent reports^3-6 have called attention to striking chest wall tenderness as a manifestation of pulmonary infarction.Dreyfuss and Weiland further stated that if no cause for the tenderness is obvious, pulmonary embolism should be seriously considered. I contend that when the cause is not obvious, many diagnostic considerations exist. Apart