A 58-year-old woman presents to the emergency department complaining of severe chest pain that began the previous evening. She describes the pain as sharp, pleuritic, and localized to the center of her chest. It radiates to the trapezius ridge on the left. The pain is exacerbated when she lies flat and significantly improves when she sits up and leans forward. She reports a dry cough and mild fatigue, noting she had a “bad cold” approximately two weeks ago. Her medical history is significant only for mild hypertension, for which she takes amlodipine. She denies recent travel, tick bites, or illicit drug use.

She appears uncomfortable and anxious. She is afebrile. Her blood pressure is 128/82 mmHg with a heart rate of 98 bpm and a respiratory rate of 18 breaths per minute. She is alert and oriented. Mucous membranes are moist.