An 18-year-old man with a history of asthma presented at a rural hospital with shortness of breath and left shoulder pain. A chest radiograph was obtained, which demonstrated a left pneumothorax; it was decompressed by means of a Foley catheter. The patient had had a similar episode with a similar chest radiograph 3 weeks previously. His medical history was significant for asthma, for which he used multiple inhalers. Results of physical examination showed a cachectic man, 1.6 m tall who weighed 42.3 kg. His vital signs were stable, with a blood pressure of 110/80 mm Hg, apulse of 80 beats/min, and a respiratory rate of 20/min. His lungs were clear to auscultation, and the cardiac examination showed a 2/6 systolic ejection murmur. The patient was transferred to our facility for further management of a recurrent pneumothorax. On arrival at our facility, a chest radiograph was obtained (Figure).