Pneumonia, poo-monia or poo-mothorax?

An unexpected respiratory finding provides a clue to an unusual diagnosis

Darren is a 28-year-old casual farmhand who presents with a two-week history of progressive dyspnoea, dry cough, left-sided pleuritic chest pain and a low-grade fever.

He has had a negative COVID-19 PCR swab the day prior to attending for review.

His past history includes thoracic and abdominal trauma following a bike accident as a teenager, anxiety and depression.

He has no current regular medications and no known drug allergies. 

Darren is a smoker, including using cannabis