Teen With Dyspnea After Chest Wall Trauma

Poll

X-rays offer no clue to the cause of dyspnea in this teen who cannot take a deep breath after crashed on his bicycle. Watch the short video, read the clues, and make your diagnosis.

This 17-year-old is unable to take a deep breath after sustaining chest wall trauma during a bike crash. Now, in the ED, he is afebrile; heart rate: 69 beats/min; respiratory rate, 55 breaths/min; BP, 126/87 mmHG; SpO2, 99% on nonrebreather mask. He is otherwise healthy and takes no medications. The initial radiograph was read as normal by the radiologist.

What do you suspect is the cause of the dyspnea?

A. Pneumothorax
B. Rib fracture
C. Clavicle fracture
D. Hemothorax
E. Brachial plexus/phrenic nerve injury
F. Commotio cordis
G. Myocardial contusion
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