FROM A TRAUMA SCHOOL TO THE EMERGENCY ROOM: A CASE STUDY OF A RARE CONDITION IN PRIMARY CARE

Situations like pneumothorax or hemothorax are rare. However, physicians must be aware to a quick diagnose. Interviews and clinical file consulting Young male, 14 years old, inserted in a nuclear family, stage V in Duvall family life cycle, present in acute disease appointment with pain in his right shoulder and right chest (which got worst in the last 24 hours and during inspiration) since 2 weeks ago, when a trauma occurred. He’s tall, thin (BMI: 17.5 kg/m2), non-smoker, plays trombone. There are no other abnormal findings in anamnesis or in familiar history. In physical exam there was diminished breath sounds in 1/3 inferior of right chest, with dullness in percussion. There were no other abnormal findings. The patient was transferred to Children’s Hospital. An X-ray was executed, revealing a right voluminous pneumothorax in hilum and pleural fluid in costophrenic angle. It was prescribed high flow oxygen and analgesic, and he was transferred to internment for vigilance. During the 5 days of internment there was significant reduction in pneumothorax and pleural fluid volume. He had medical discharge to home with indication for no performing physical activity or playing instruments. Traumatic hemothorax and pneumothorax was the most plausible diagnose, since there is a trauma coincident with the affected area. However, the phenotypic characteristics and wind instrument play have a role. Althought not so common, situations like this must aware the physician to perform a quick and accurate diagnoses for a right referral and treatment.