Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 23-year-old man who presents to the ED with a 2-hour history of sudden-onset shortness of breath and chest pain. No associated cough. No subjective fever or chills. PMH is unremarkable. Social Hx: he is a full-time graduate student in mechanical engineering. He exercises regularly and plays basketball in a university recreational league. On exam he is noted to be in moderate distress. He appears tall and thin. The patient is tachypneic (30) and breathing is shallow. Breath sounds are severely diminished with faint wheezing on auscultation over the right lung fields. No adventitious sounds are appreciated over the left lung fields. He is tachycardic with a HR of 132. The remainder of the exam is unremarkable.
CXR shows right-sided pneumothorax with slight leftward mediastinal shift.