December 2016 pulmonary case of the month

No abstract available. Article truncated after 150 words. History of Present Illness: The patient is a 29-year-old man who presented to the emergency room with right-sided pleuritic chest pain, fever, cough, and progressive dyspnea over 2 weeks. Past Medical History, Social History and Family History: He had no prior significant medical issues and had been well until 2 weeks ago. A native of India, he has been in the US for about 5 months and works at American Express. He is a nonsmoker. Family history is noncontributory. Physical Examination: Vitals signs: Temperature 38.0◦ C, Blood Pressure 155/85 mm Hg, Heart Rate 140 beats/min, Respirations 24 breaths/min; General: Appears to be in moderate pain and respiratory distress; Lungs: Decreased breath sounds on the right; Heart: regular rhythm with a tachycardia; Abdomen: unremarkable; Extremities: unremarkable; Neurologic: unremarkable. Radiography: His initial chest x-ray is shown in Figure 1. Which of the following best describes the chest x-ray? 1. Elevated right hemidiaphragm