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Download the article PDF: Clinical Image Challenges March 2026
A 51-year-old male presents to urgent care after falling while skiing. He reports catching an edge in a patch of slushy snow, causing him to pitch forward and land forcefully onto his left anterior chest. He immediately experienced localized pain over the left chest, worsened by deep inspiration and coughing. He denies shortness of breath, syncope, and neck or head trauma. On exam, vital signs are normal. There is focal tenderness over the left anterior chest wall at the level of the 4th rib but no visible ecchymosis, crepitus, or deformity. On auscultation, lung sounds are clear and equal bilaterally.
A chest x-ray shows no acute bony abnormalities or pneumothorax. Due to persistent focal tenderness and concern for a clinically significant injury, a point-of-care ultrasound (POCUS) is performed at the area of maximal pain.
View the ultrasound image and consider the likely diagnosis and next steps. The resolution of the case is described on the following page.