A helmet to the flank.

Volume 90, Number 2 www.aafp.org/afp American Family Physician 119 A 16-year-old boy presented to the emergency department approximately 30 minutes after he was injured during a football game. He was hit in the left flank by a helmet during a tackle. He felt short of breath and had sharp, stabbing pain on deep inspiration. He was able to speak in full sentences. He was healthy and was not taking any medications or supplements. Physical examination revealed a heart rate of 82 beats per minute, respiratory rate of 20 breaths per minute, and a blood pressure of 130/74 mm Hg. His left f lank was tender to palpation, but there was no ecchymosis or palpable abdominal mass. Urinalysis and serum creatinine findings were normal. Computed tomography was performed (Figures 1 and 2).