Spontaneous Pleuritic Chest Pain In An Otherwise Healthy 22 Year Old Collegiate Athlete

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HISTORY: Patient is a 22 year old collegiate basketball player that initially presented to urgent care facility with several days of right sided chest pain. At that time, it was determined patient had intercostal muscle spasms and was given steroid dose pack with minimal improvement. Approximately 2 months later, patient began having severe shortness of breath, limiting him from practicing, so ATC sent him to our clinic for further evaluation. He was found to have no lung sliding on limited US and was sent to ED with proper handoff. At that time, CXR showed complete right sided pneumothorax and chest tube was placed. Patient had improvement and was discharged several days later after chest tube was pulled. He presented back to the ED several days later with new onset chest pain and was found to have recurrence. He underwent blebectomy and pleurodesis and had uncomplicated postoperative course. PHYSICAL EXAMINATION: Patient was alert and oriented x3 and in NAD at each encounter. During each encounter for pneumothorax, patient had substernal chest pain that radiated to the right side under his pectoral muscles. This pain was not reproducible to palpation. He had mild tachypnea and some degree of SOB with maintained O2 saturation. Left lung was clear to auscultation. On the right side, he had decreased lung sounds, but no wheeze or crackles. He had regular rate and rhythm with no murmurs, rubs, gallops noted. He was mildly tachycardic. He was neurovascularly intact. DIFFERENTIAL DIAGNOSIS: Pneumothorax, costochondritis, pulmonary embolism, asthma TEST AND RESULTS: Limited Lung Ultrasound: No sliding in R1 and R2 positions CXR: Large right pneumothorax EKG: NSRCXR after chest tube: Reinflated lung with chest tube in place FINAL WORKING DIAGNOSIS: Complete Right Spontaneous Pneumothorax TREATMENT AND OUTCOMES: Patient had successful reinflation after initial chest tube, but unfortunately had recurrence. Since second admission requiring lobectomy and pleurodesis with second chest tube, patient is much improved. He is in close follow up with thoracic surgery and is in graded return to activity program with plan to get back to full activity on the basketball court as soon as possible.

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