An otherwise healthy 24 yoM presents to the ED with complain | Figure 1

BrownEM

Residency Program

An otherwise healthy 24 yoM presents to the ED with complaint of shortness of breath, pleuritic chest pain, and cough. He reports that earlier in the day he was spear fishing while free-diving earlier that day up to 50 feet deep. After surfacing from one of the dives he began coughing up some bright red blood. Despite this, he went on another dive and surfaced with the pain described above and continued coughing. On arrival to the ED he was breathing comfortably on room air. Vitals within normal limits. Lung sounds were surprisingly clear without any increased work of breathing. His coughing had resolved but he still felt short of breath. A chest x-ray was performed which lead to a CT scan as shown. What does the imaging show? What is your likely diagnosis? How would you manage this patient? If you were in a rural setting, who could you potentially turn to for help in managing this case?

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