A 20-year-old male playing basketball has chest pain with diminished breath sounds on the left and high blood pressure. Which diagnosis is most likely?

• A. Tension pneumothorax
• B. Simple pneumothorax
• C. Heat exhaustion
• D. Heat stroke

Answer: (B)

The main idea here is recognizing how a pneumothorax presents and how the patient’s vital signs help distinguish between types. A pneumothorax causes chest pain and decreased breath sounds on the affected side because air is pocketing in the pleural space and the lung on that side may partly collapse. If the patient remains hemodynamically stable, with normal or even elevated blood pressure and no signs of shock, this points toward a simple pneumothorax rather than a tension pneumothorax.

In a simple pneumothorax, the lung on one side collapses enough to reduce breath sounds but there isn’t yet compression of the heart and great vessels. The patient can be in pain and short of breath, but blood pressure tends not to drop aggressively. In contrast, a tension pneumothorax involves air trapping that builds pressure, shifting the mediastinum, obstructing venous return, and typically causing hypotension and other signs of instability—tracheal deviation, distended neck veins, and severe distress.

Heat exhaustion and heat stroke involve overheating and dehydration signs, not unilateral chest findings. So the combination of chest pain with diminished breath sounds on one side and stable or high blood pressure best fits a simple pneumothorax.