mrcem2-2028

mrcem2-2028

A 35-year-old woman is brought in by ambulance after being hit by a car while walking. She is brought to the resuscitation area of your Emergency Department complaining of abdominal and pain on the left side of her chest. There is bruising on the left side of her chest but no visible open wounds. She is experiencing severe shortness of breath, and her vital signs are HR 112, BP 88/51, SaO2 88% on high flow oxygen. Upon examining her chest, you observe that her trachea is deviated to the right and there are no breath sounds and a hyper-resonant percussion note on the left side of her chest. Additionally, she has distended neck veins.
What is the SINGLE most likely diagnosis?