A 45-year-old male is brought to the emergency department after a high-speed motor vehicle collision. He is presenting with severe chest pain and difficulty breathing. On physical examination, you note paradoxical movement of a portion of his chest wall during respiration. What is the most likely diagnosis?
The most likely diagnosis is a flail chest, indicated by the paradoxical movement of the chest wall segment. This injury results when multiple adjacent ribs are fractured in at least two places, creating a free-floating segment that moves inward on inspiration and outward on expiration. Pneumothorax, tension pneumothorax and hemothorax can also produce dyspnea and chest pain but do not cause a discrete paradoxically moving chest wall segment.
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