Working Diagnosis:
Left apical traumatic pneumothorax

Treatment:
The patient was seen for follow-up ten days after discharge from the hospital and had resolution of his shortness of breath with pain improved to 2 out of 10 with deep breathing and twisting. He also had migrating chest pain that gradually improved. He was instructed to continue to avoid physical activity and air travel for the next 2 to 4 weeks. At 3 weeks he was symptom-free with a normal chest x-ray. He was provided with a plan for a gradual return to physical activity over a week as long as he remained symptom-free. There were no further complications and he was able to resume full physical activity.

Outcome:
After initial evaluation, the patient was admitted to the hospital for observation overnight. There was a stable appearance of his pneumothorax on x-ray, and his vital signs were stable overnight. His pain was improved, and he was breathing comfortably by the morning. He was discharged home from the hospital with instructions to avoid flying, contact activity, or any moderate physical activity until seen in follow-up. He was also advised to use the incentive spirometer for 3 to 4 days and then as needed.

Author's Comments:
Traumatic pneumothorax is an uncommon injury during athletic events, although it could lead to significant morbidity if overlooked. While most athletes with acute chest trauma typically have contusions or rib fractures, it is important to consider a traumatic pneumothorax within the differential, along with other serious diagnoses such as cardiac arrest or arrhythmias. If unnoticed, patients could deteriorate quickly. Thankfully, this patient did not need significant interventions after his injury.

Editor's Comments:
Rib fractures, pneumothorax, tension pneumothorax, hemothorax, flail chest, steronoclavicular joint dislocation, pulmonary contusions, and cardiac contusions can occur during sporting activities. In order to make the correct diagnosis, one must consider all of these diagnoses. More common in higher energy traumatic injuries involving motor vehicle accidents, these can occur in sports as well.

A missed pneumothorax can lead to cardiorespiratory arrest and death.

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