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ABSTRACT

monary fibrosis (2). The reported incidence of primary spontaneous pneumothorax is 18 to 28 per 100 000 per year in men and 1.2 to six per 100 000 per year in women (1). Mortality is greater in men than in women.A tension pneumothorax is usually associated with trauma or mechanical ventilation and the incidence of spontaneous development is rare. A spontaneous tension pneumothorax may complicate one to three per cent of unrecognized pneumothoraces (3). This feared complication typically presents with obvious respiratory distress and signs of cardiovascular instability requiring emergency needle decompression and tube thoracostomy.Presented is an interesting case of a young female who presented to the Emergency Room with right-sided chest pain

CASE REPORTA 59-year old male with no known chronic medical illnesses presented with a five-day history of constipation and not being able to walk. He reported no history of trauma, back pain, viral type symptoms, or nausea but gave a six-month history of shortness of breath. He denied cough, haemoptysis, palpitations, or chest pain. Of note, he had a 30-packyear smoking history and reported significant weight loss and anorexia over several months.On examination, the patient was tachycardic at 102 beats/minute, tachypnoeic at 32 breaths/minute and had an oxygen saturation of 84% on room air. He had right-sided ptosis and obvious anhydrosis on the right side of his face (Horner's syndrome) with distended neck veins on the right and fullness in the right supraclavicular region (Fig. 1). His right pupil was constricted (Fig. 2). Cranial nerve examination was otherwise unremarkable. Respiratory examination revealed decreased chest expansion on the right, with tracheal deviation to the left, dullness to percussion and absent breath sounds in the right upper-mid zones. He was fully alert with a Glasgow coma scale of 15/15.

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