Pneumothorax in a patient with COPD after blunt trauma

A 53-year-old man with a history of heavy tobacco use presented with shortness of breath. Eight days prior to his presentation he was diagnosed with multiple rib fractures after suffering an assault. Since then he had developed dyspnea and a nonproductive cough. A chest x-ray revealed a large pneumothorax on the right with approximately 80% volume loss (arrow, Figure 1). Tube thoracostomy was performed. Repeat chest x-ray showed that the pneumothorax had resolved, revealing a consolidation likely caused by either reexpansion pulmonary edema or, given its location in the superior segment of the right lower lobe, aspiration pneumonia (thin arrow, Figure 2). Also seen in the x-ray is an old scar (thick arrow, Figure 2) and apical bullous changes with hyperinflated lungs suggestive of chronic obstructive pulmonary disease (COPD).