A man in his 70s presented to the ED with left-sided chest pain and shortness of breath. The chest pain was pleuritic, localized to the left upper anterior chest, and occurred at rest. He also reported hematuria that started the morning of admission. His medical history was significant for hypertension, and his only medication was hydrochlorothiazide.
Physical examination revealed a thin man who appeared uncomfortable and tachypneic. He was afebrile, with a heart rate of 110 beats per minute, BP of 160/90 mm Hg, respiratory rate of 24 breaths per minute, and oxygen saturation on room air of 92%. Lung examination revealed decreased breath sounds over the entire left hemithorax, with dullness to percussion. Right lung auscultation was normal. Heart sounds revealed normal S1 and S2 sounds, but tachycardic. There was no evidence of jugular venous distention. Abdominal examination was unremarkable, and there was no pitting edema of the lower extremities. Chest radiograph revealed a left-sided opacity and a blunted left costophrenic angle (Fig 1).