Patient ,with shortness of breath and chest pain

A 18-year-old male patient ,complaints of shortness of breath and chest pain which started one day ago. The shortness of breath was mild in severity, made worse by exertion and relieved with rest, associated with pleuritic chest pain, left sided, 5-6/10, sharp in nature. He denied any similar symptoms in the past.

PMHx,
He also denied any use of illicit drug like cocaine or and any history of trauma. He did not have any past medical history or past surgical history. He had no family history of premature CAD or asthma. He did not smoke or drink alcohol. He was on no prescription medications and he participated in sports without any difficulty.

O/E
Blood pressure was 112/70 mm/Hg, HR 90 bpm, temp. 98.7 F and RR was 23/min, SpO2 90 % on room air. His height was 5’10’’ with BMI of 19.9. He was in mild respiratory distress. HENT exam was unremarkable. No crepitus was felt. Trachea was in the midline. On auscultation, there were no breath sounds on the left side with hyperresonance on percussion. S1 and S2 were normal with no murmurs/rubs or gallops. The abdomen was unremarkable. No pedal edema was appreciated. No clinical stigmata of Marfan’s syndrome like high arched palate or increased arm span were observed.

Chest X-ray
image

  1. Comment on the Chest X-ray  ???
  2. What is your  Dx for this patient???
  3. How you are going to Rx this patient???


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