ABSTRACT
Phileus Fogg, an English gentleman, presents to your emergency department complaining of shortness of breath. He also complains of some pain on breathing in deeply but thinks he probably pulled a muscle with heavy lifting. He is normally fit and well with no systemic symptoms. He occasionally smokes a pipe. He also reports having recently got back from a ‘round the world trip’ that took him 80 days. This involved long periods of travelling in cramped conditions, including a long trip on a paddle steamer. On examination, his BP is 125/70, heart rate is 125 and regular and his oxygen saturations are 93% on air. He is afebrile and you notice that his left leg is swollen and warm, but Mr Fogg says, ‘don’t worry about that, it is probably from a bite or something.’ A chest radiograph is unremarkable and an ECG shows a sinus tachycardia.
