Clinical—A 55-year-old man presented with a 4-day history of shortness of breath and productive cough. The patient had a long-standing history of shortness of breath on exertion and a 35-pack year smoking history, but no prior hospital admissions. Family history was significant with 2 first-degree relatives affected by severe respiratory disease, not otherwise specified. A chest radiograph was performed (Figure 1). Figure 1. PA chest radiograph What is the diagnosis and management? Answer, Figure 2, and Discussion ‘Tension' bullae have been previously reported, again mimicking a tension pneumothorax,1highlighting the fact that a tension pneumothorax is an emergency situation and the diagnosis is generally based on clinical findings rather than imaging.

Clinical—A 55-year-old man presented with a 4-day history of shortness of breath and productive cough. The patient had a long-standing history of shortness of breath on exertion and a 35-pack year smoking history, but no prior hospital admissions. Family history was significant with 2 first-degree relatives affected by severe respiratory disease, not otherwise specified. A chest radiograph was performed (Figure 1). Figure 1. PA chest radiograph What is the diagnosis and management? Answer, Figure 2, and Discussion ‘Tension' bullae have been previously reported, again mimicking a tension pneumothorax,1highlighting the fact that a tension pneumothorax is an emergency situation and the diagnosis is generally based on clinical findings rather than imaging.