A young man developed sudden shortness of breath and a sharp pain during inspiration while playing basketball. He presented to A&E and the above chest x-ray was taken. What is the most likely diagnosis?

A) Tension pneumothorax.
B) Acute asthma attack.
C) Pulmonary embolus.
D) Spontaneous pneumothorax.
E) Hyperventilation secondary to panic attack.




The answer is D. Young tall men who develop sudden onset shortness of breath and pleurtitic chest pain might as well have "spontaneous pneumothorax" stamped on their heads. Although this may become a tension pneumothorax the trachea is currently in the midline. Treatment involves the placing of a seldinger-type chest drain to re-expand the lung, as can be seen here:

Both images courtesy of Dr Jeremy Jones, Radiopaedia.org. (Original file here) Creative Commons BY-SA-NC