Clinical Practice and Cases in Emergency Medicine

Introduction: Primary spontaneous pneumothorax generally presents with symptoms of chest pain and shortness of breath. Progression to a tension pneumothorax results in a medical emergency. Rare presentations with abdominal pain are possible and must be considered to expedite appropriate treatment of pneumothorax.

Case Report: We report a case of a 21-year-old male with primary spontaneous pneumothorax who initially presented to the emergency department with right lower quadrant abdominal pain. History and physical exam were suggestive of acute appendicitis. A large right pneumothorax was incidentally found on computed tomography.

Conclusion: This case highlights unusual presentations of pneumothorax. Emergency physicians should consider atypical presentations of chest pathology such as pneumothorax in patients presenting with symptoms consistent with an acute abdomen.