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A 27-year-old man was admitted to the emergency department because of respiratory failure. Three years earlier, he had undergone surgery to repair a traumatic rupture of the left side of the diaphragm. On admission, the patient had severe respiratory distress, hypotension (blood pressure, 60/40 mm Hg), and sinus tachycardia (heart rate, 140 beats per minute). There was a rightward deviation of the trachea and distention of the neck veins. On examination, the left hemithorax was hyperresonant and without breath sounds. Heart sounds and normal breath sounds were heard to the right of the sternum. In view of the patient's history, . . . [Full Text of this Article] |
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