A 14-year-old Caucasian male presents to the Emergency Department (ED) with a chief complaint of chest pain. He participated in a wrestling meet earlier in the day and symptom onset was four hours prior to presentation. Pain is sharp and located over the left anterior neck and anterior chest. It is aggravated by deep inspiration and torso movement. Associated symptoms include dysphagia and increase in voice pitch. He denies other symptoms. He denies trauma prior to or during the wrestling meet. Prior to ED arrival, treatments tried include Airborne, Benadryl, and Ibuprofen 400mg po x 1 with no relief. Past medical history includes ADHD and seasonal allergic rhinitis. He has no history of asthma. There is no personal or family history of cardiac arrhythmia or premature cardiovascular disease. Current medications include Vyvanse 40mg po daily. He has no known medical allergies. Past surgical history includes tonsillectomy and adenoidectomy. He denies smoking, alcohol, and drug use. A 14-point review of systems is negative other than mentioned above. Pertinent negatives include absence of fever, cough, palpitations, and shortness of breath. On physical exam, vital signs including temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation are within normal limits. Height 5'10', weight 137 pounds, BMI 19.7. Patient is a tall, thin, well-nourished male who appears uncomfortable. He sits on the edge of the ED bed, leaning slightly forward and guarding against movement. Trachea is midline. Neck is soft and tender to palpation over the left paratracheal region; no crepitus, subcutaneous emphysema, increased muscle tone, or lymphadenopathy appreciated. Lungs are clear to auscultation with normal breath sounds in all fields. Heart is regular rate and rhythm with crunching sound noted over the left sternal border and apex, synchronous with the heartbeat. No murmur. Chest wall is tender to palpation over the sternum and left anterolateral wall. No costal crepitus or bony step-off appreciated. No erythema, ecchymosis, or swelling. EKG shows normal sinus rhythm with ventricular rate of 92 bpm, normal intervals and no ST-T wave abnormalities. Two-view chest x-ray reveals lucent streak along left heart border and subcutaneous emphysema along right chest wall. Two-view X-rays of the neck reveals subcutaneous air in the neck soft tissues. CBC and CMP shows leukocytosis with WBC 15.93, otherwise within normal lim...