title: [Referred with the working diagnosis 'pneumothorax: could it be another diagnosis?].
abstract: BACKGROUND
  Patients who are referred to an emergency department (ED) often have a working diagnosis. Hospital physicians may be inclined to accept this diagnosis and incorrectly link the findings of investigations to it. This may lead to an incorrect definitive diagnosis and therapy.
  
  
  METHODS
  We present the case of a 36-year-old female who was referred to the ED with a pneumothorax seen on chest x-ray. Findings from history-taking, physical examination and a second chest x-ray taken on the ED were diagnosed as being consistent with pneumothorax and a chest-drain was inserted. However, further investigation showed that she had Swyer-James-Mcleod syndrome which could have been treated conservatively.
  
  
  CONCLUSIONS
  This patient was given a chest drain after the working diagnosis of pneumothorax was made. Due to the definite diagnosis of Swyer-James-Mcleod the indication for chest drainage may have been incorrect. If a diagnosis of pneumothorax is suspected, but diagnostic findings suggest otherwise, further investigations should be performed before a chest drain is inserted.
authors.affiliation: Zorggroep Treant, locatie Scheper Ziekenhuis Emmen, afd. Longziekten, Emmen.
authors.forename: Romkje Sietske
authors.initials: RS
authors.lastname: Hospes
authors.forename: Steven R
authors.initials: SR
authors.lastname: Rutgers
mesh_terms: D000328:Adult; D015505:Chest Tubes; D003937:Diagnosis, Differential; D004322:Drainage; D005260:Female; D006801:Humans; D019568:Lung, Hyperlucent / Q000175:diagnosis*; D011030:Pneumothorax / Q000175:diagnosis*; D013902:Radiography, Thoracic; D019564:Unnecessary Procedures