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Tension pneumothorax: A 25-year-old man was brought to the emergency department after having been hit in the left lateral chest with a jet ski. He was short of breath and hypotensive. On examination, there was evidence of right tracheal deviation and absent breath sounds on the left. The chest x-ray (which should not have been obtained) reveals a shift of the mediastinal structures to the right and absence of lung markings in the left lung field consistent with a tension pneumothorax. (L.S.)