A 26-year-old man is stabbed in the right intercostal space in the midclavicular line and presents to the emergency department. On examination, subcutaneous emphysema of the right chest wall, absent breath sounds, and a trachea shifted to the left are noted. What is the most likely serious diagnosis?
High-Yield Explanation
Shift of the trachea strongly suggests a tension pneumothorax. Subcutaneous emphysema is also more common with a tension pneumothorax than with the other conditions listed. Simple pneumothorax and chest wall laceration are much less serious injuries than tension pneumothorax.