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A Hydropneumothorax That Never Was!

      A 28-year-old female-to-male transgender patient with unknown medical history was brought to the ED after being found unresponsive in the street with a helmet on his head. Trauma code was activated for presumed traumatic event. He was afebrile with normal BP, however, and was bradycardic at 54 beats/min and hypoxemic to 90% oxygen saturation on ambient air. His respirations were unlabored at 16 breaths/min. The patient was comatose with Glasgow coma scale of 7. Lung auscultation revealed decreased breath sounds on the left hemithorax. He was noted to have faint thoracic scarring bilaterally, which was presumed to be from bilateral mastectomies, along with acute deep abrasions suggestive of friction injuries with a dominant left-sided distribution. Cardiac and abdominal examination was unremarkable. Due to audible oropharyngeal secretions and signs of vomit on his clothing, the decision was made to proceed with intubation for airway protection.
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