Case presentation A 26-year-old man presented to the emergency department with severe pain involving the entire left hemithorax, which had started suddenly during a family dinner 36 hours earlier. A family physician, who was also attending the gathering, performed an initial examination.

Initial examination during the episode Ectomorphic biotype Eupneic and pale Facies of pain Reduced chest wall movement over the left hemithorax Cardiac auscultation : Rhythmic, slightly muffled S1 and S2 sounds Pulmonary auscultation Absent breath sounds over the upper and lower thirds of the left hemithorax Markedly diminished breath sounds over the middle third Emergency department presentation Following referral by the family physician, the patient presented to the emergency department with sharp, stabbing, nonradiating pain rated 7/10 on the visual analog scale. The pain was associated with…