Differential Diagnosis for a 50-year-old man with road traffic accident injuries

Single most likely diagnosis

• Tension Pneumothorax: The patient has reduced chest expansion on the right side, which is consistent with a pneumothorax. The low blood pressure (80/60 mmHg) and high pulse rate (104/min) suggest hypovolemic shock, which can be caused by a tension pneumothorax. However, the absence of visible JVP (Jugular Venous Pressure) makes this less likely, but it's still a possibility due to the mechanism of injury and symptoms.

Other Likely diagnoses

• Hemothorax: Given the mechanism of injury (road traffic accident) and the symptoms (reduced chest expansion, hypotension), a hemothorax is a strong possibility. The presence of a femoral fracture also suggests significant trauma, which increases the likelihood of internal bleeding.
• Pulmonary Contusion: The patient's history of a road traffic accident and the presence of injuries on the right chest make pulmonary contusion a likely diagnosis. This could lead to reduced chest expansion and respiratory distress.
• Hypovolemic Shock due to Femoral Fracture: The femoral fracture could be causing significant blood loss, leading to hypovolemic shock, which is consistent with the patient's low blood pressure and high pulse rate.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

• Cardiac Tamponade: Although the heart sounds are normal, cardiac tamponade is a life-threatening condition that can occur after a chest trauma. It's essential to consider this diagnosis, especially if the patient's condition deteriorates.
• Massive Pulmonary Embolism: While less likely, a massive pulmonary embolism could occur, especially in the context of a femoral fracture and immobilization. This would be a deadly condition if missed.
• Aortic Dissection or Rupture: Given the mechanism of injury, an aortic dissection or rupture is a possibility, although less likely. This condition would require immediate attention.

Rare diagnoses

• Diaphragmatic Rupture: This is a rare but possible diagnosis, especially with the mechanism of injury. It could lead to reduced chest expansion and respiratory distress.
• Traumatic Asphyxia: This condition occurs due to severe compression of the chest and abdomen, leading to respiratory distress and potentially life-threatening complications. It's a rare diagnosis but should be considered in the context of severe trauma.