A 27 year-old female presents to the emergency department with chief complaint of right-sided shoulder pain radiating to the chest that started 3 days ago.
She reports that the pain was initially very severe and exacerbated by every breath on the first day of symptoms. The pain began after waking that morning. The patient went to a local urgent care clinic where she had a shoulder x-ray done that did not show a fracture or dislocation and was discharged with the diagnosis of impingement syndrome. The pain has improved somewhat over the last 2 days but has continues to experience pain with deep inspiration. The pain is also made worse by lying flat.
She denies any recent trauma to her shoulder or chest. She also denies any history of recent long car or plane rides, OCP use, recent surgery, or prior deep venous thrombosis.
She denies any recent trauma to her shoulder or chest. She also denies any history of recent long car or plane rides, OCP use, recent surgery, or prior deep venous thrombosis.
She denies having any shortness of breath, fevers, chills, nausea or vomiting.
Vital signs are within normal limits. The patient appears resting comfortably in bed.
Vital signs are within normal limits. The patient appears resting comfortably in bed.
A 2-view chest x-ray was obtained and is shown below:
What is the diagnosis?
How would you manage this patient?
Share your thoughts in the comments section below.
The diagnosis for this case will be posted in approximately 1 week.
Rt sided small pneumothorax
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