A 22-year-old male arrived at the Emergency Department around midnight, complaining of chest pain and shortness of breath. It was his second visit to the ED in as many weeks; just 14 days earlier, he had come in with a respiratory infection, which was treated with antibiotics. The patient’s malaise and fatigue had continued, however.

He presented the second time in severe distress. He had no nausea, vomiting or fever, but in addition to the chest pain and dyspnea, he had a rash on his extremities. Because his symptoms were worsening, with increasing dyspnea, tachycardia and a rise in blood pressure to 172/102, we decided to perform a bedside ultrasound exam with Vscan.