Chest pain is a common chief complaint of patient presentation to the emergency room. It also presents itself as one of the most challenging symptoms for clinicians to manage. The differential diagnosis for chest pain involves a multitude of organ systems. Failure to recognize potentially serious life-threatening causes such as acute ischemic heart disease, aortic dissection, tension pneumothorax, or pulmonary embolism can lead to serious morbidity and mortality. At the same time, overly conservative management of low-risk patients leads to unnecessary hospital admissions, studies and procedures.1 The following case illustrates the need to broaden the differential diagnosis for chest pain once life-threatening causes have been ruled out.