Shortness of Breath and Chest Pain in Two Females

Thirty-year-old twin sisters were brought to the emergency department (ED) after a motor vehicle crash. One was the driver and the other, the front-seated passenger. The car was left-hand driven, with regular seatbelts and without an air bag system. According to the sisters' statements, the car hit on the front and caused a sudden stop. On arrival to the ED, both of them complained of shortness of breath and chest pain identical to the side where the seatbelt lies. Asymmetric reduced breathing sound was observed on both of them, in the opposite side. The vital signs were normal, and other examinations were nonspecific.

Diagnosis 

Pneumothorax. Pneumothorax was suspected in both women, and confirmation was proved by the chest radiograph (Figure). Simultaneous isolated pneumothorax related to sudden compression of chest by the seatbelt is uncommon.1 Both patients underwent tube thoracostomy. Their recovery was uneventful.

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Figure. Chest radiographs (left, the front-seated passenger; right, the driver). Used with permission of Yung-Cheng Su, MD, Emergency Department, Belau National Hospital, Palau.