This case of a sudden onset of a tension pneumothorax in an otherwise healthy young male demonstrates the necessity to look for the obvious pathology. Although the patient complained about pain in the left chest radiating to the left arm, acute myocardial infarction is less likely than a pneumothorax, especially in this young patient with no history of heart disease.

As the patient was >2.0 m in height, aortic dissection due to undetected Marfan disease was also suspected by the radiologist and should be considered in the differential diagnoses for this case. Marfan disease is also a risk factor for pneumothorax.

As the vital signs were stable, the patient was immediately transferred to the emergency department for tube thoracostomy rather than performing an emergency needle thoracocentesis.