A 37 yo male with no sig PMH presents with pleuritic chest pain for 3 days.  He denies shortness of breath.  Chest xray is shown.  What's the diagnosis?  Scroll down for answer.

Answer:  Large right sided spontaneous pneumothorax

• Pneumothorax occurs when air enters the potential space between the visceral and parietal pleura in the chest cavity
• Tension pneumothorax can be diagnosed by evidence of shifting of the mediastinal contents away from the side of the pneumothorax
• Treatment options for pneumothorax include oxygen, observation, needle or catheter aspiration, and tube throacostomy
• First time, stable pneumothorax of <20% lung volume can be initially treated with observation and oxygen - at least 4 hours of observation on supplemental oxygen and then repeat radiograph
• Any moderate or large pneumothorax or any patient with hemodynamic instability or hypoxia should be treated with tube thoracostomy, which may be a pigtail catheter or surgical chest tube

References

Tintinalli et al.  Tintinalli’s Emergency Medicine: A Comprehensive Study Guide.  8^th Ed.  New York:  McGraw hill Education, 2016. Print