Abstract

A 21-year-old previously healthy male presented to the emergency treatment unit with left-sided chest pain radiating to the left shoulder, which had worsened since the morning. The patient also experienced diarrhea (three episodes), vomiting (two episodes), and intermittent dyspnea. His history was largely unremarkable except for a significant smoking history—10-15 cigarettes per day for the past six years. On examination, the patient was in severe pain and appeared pale, with notable tachypnea (respiratory rate of 30 breaths per minute) and a rapid, regular pulse of 130 beats per minute. Physical findings were concerning: tracheal deviation to the right, hyperresonance on the left side of the chest, and reduced air entry on the left side. Despite these findings, the patient maintained a high oxygen saturation (SpO2 of 100% on room air). However, his blood pressure was dangerously low at 85/60 mmHg, raising the suspicion of a secondary spontaneous pneumothorax, likely complicated by a pleural effusion.