ABSTRACT
A 16-year-old male smoker with no significant past medical history presents with a 12-hour history of increasing left chest pain and some difficulty breathing. The pain is severely exacerbated with attempts to take a deep breath, resulting in a sensation of air hunger. On examination, the patient is a tall, thin young man who appears moderately anxious and uncomfortable. Vital signs are as follows: heart rate, 105 beats per minute; blood pressure, 116/76 mm Hg; respiratory rate, 22 breaths per minute; temperature, 37.2°C; and oxygen saturation, 98% on room air. The trachea is midline. Breathing is not labored. Auscultation of the chest reveals clearly diminished breath sounds in the left chest. An upright postero-anterior chest x-ray has been performed and is shown in Figure 15.1.
