After playing soccer, a 25-year-old male has shortness of breath and diminished breath sounds over the right upper thorax. What condition should you suspect?

• A. Spontaneous pneumothorax
• B. Pleuritis
• C. Costochondritis
• D. PE

Answer: (A)

A spontaneous pneumothorax is suspected when a person has sudden shortness of breath with unilateral, diminished breath sounds—in this case, over the right upper chest. It happens when air leaks into the pleural space, often from rupture of a small apical bleb, causing partial collapse of the lung on that side. The diminished breath sounds reflect the lung not fully expanding where the air has collected.

Pleuritis can cause sharp, pleuritic chest pain and shallow breathing but typically doesn’t produce a localized loss of breath sounds. Costochondritis is chest wall pain without lung findings. A pulmonary embolism can cause sudden dyspnea as well, but breath sounds are usually normal or not markedly decreased in a single chest region.