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Pleuritic Chest Pain in a 23-year-old Woman

Pleuritic Chest Pain in a 23-year-old Woman

Pneumothorax, spontaneous
A 23-year-old woman presents to her primary care provider with 6 days of right sided pleuritic chest pain that started during a recent vacation abroad. She denies any injury and is not short of breath at rest, but is short of breath when she walks. Since it wasn’t “that bad” she decided to finish her vacation and wait to see a doctor on returning home. Her past medical history is notable only for GERD. Her medications include omeprazole and birth control pills.
Her vital signs and pulse oximetry are normal except for a pulse of 108 and she appears to be in no acute distress. Head and neck exam are normal with no tenderness or JVD. Heart sounds are normal but breath sounds are decreased on the right. The abdomen is benign and the extremities are atraumatic without edema or cords. Her chest x-ray is shown above.

-- What finding is demonstrated?  
-- What other imaging tests would you order? 
-- How should the patient be treated?  


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