Chest Injury in a Soccer Player

Abstract

HISTORY: A 24 year-old female collegiate soccer player presented 3 days after a collision injury. While playing soccer she was struck on the left side of chest by a male soccer player. Witnesses nearby told her they heard a pop at the time of collision. Since the game, she had been wrapping her chest with an ACE wrap and taking Tylenol 1000mg twice daily with mild relief. She denied hemoptysis but had some left sided chest tightness with walking about 100 feet. She complained of pain with deep inspiration and difficulty sleeping. She felt her pain was improving until she lifted her 2 year-old niece 1 day prior to presentation, when it acutely worsened. PHYSICAL EXAM: Examination in the clinic. Vital signs: Pulse 84 Blood pressure 110/80. Oxygen saturation was 98% on room air and with brisk walking. Trachea midline, jugular veins non-distended. Tenderness to palpation over ribs 4–6 in the mid-axillary line without ecchymosis or step-off appreciated. Normal respiratory effort. On auscultation, there were diminished breath sounds at the left apex. Pain noted with deep inspiration. Abdomen without obvious deformity or ecchymosis, nontender, normal bowel sounds, no hepatosplenomegaly. DIFFERENTIAL DIAGNOSIS: 1. Rib fracture 2. Rib contusion 3. Lung contusion 4. Pneumothorax TESTS AND RESULTS: 6/17/15 – CXR – Large left-sided apical pneumothorax measuring 3–3.5 cm (approximately 30-35%). – No rib fractures seen 6/18/15 – CXR status post CT-guided placement of chest tube – Much improved left-sided pneumothorax measuring 5 mm from the apex with small-caliber chest tube overlying 2nd-3rd intercostal space FINAL DIAGNOSIS: 1. Traumatic left-sided apical pneumothorax 2. Non-displaced left-sided rib fracture TREATMENT AND OUTCOMES: 1. CT-guided chest tube placement with removal after 2 hours. 2. Continue ACE wrap for comfort. 3. Rest with return-to-play progression over 5 weeks post chest tube. 4. Patient had return of mild chest pain 10 weeks after chest tube placement but repeat chest x-ray showed no return of pneumothorax. Progressed well back to playing soccer without further complication.