Description
A 56-year-old white woman with a history of chronic obstructive pulmonary disease, hypertension, deep vein thrombosis and chronic alcohol abuse was brought to the emergency room after having two episodes of seizures at home. She was confused and could not give any history. Vital signs were stable and limited neurological exam was unremarkable except for confusion. CT scan of the head was negative for any acute intracranial abnormality and she was admitted for presumed alcohol withdrawal. Soon after admission, she developed shortness of breath, tachycardia and a low-grade fever. On auscultation, she was found to have no breath sounds on the right and a chest X-ray was obtained which showed a large lucency occupying the majority of the right hemithorax (figure 1). The next question for us was if this was a tension pneumothorax and if the patient needs an urgent tube thoracostomy. However, because...
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