A 60-year-old man undergoes coronary artery bypass grafting (CABG). On the third postoperative day, he develops sudden-onset severe shortness of brea…

The clinical picture of respiratory distress, absent breath sounds, dullness to percussion (or hyperresonance if tension pneumothorax, but dullness points to massive effusion/hemothorax or complete lung collapse), and tracheal deviation suggests a significant intrathoracic collection or tension phenomenon post-operatively. However, deviation to the opposite side with absent breath sounds and dullness points to a massive hemothorax or pleural effusion requiring urgent tube thoracostomy (chest tube). Note: If tracheal deviation is away from the pathology with hyperresonance, it is a tension pneumothorax needing needle decompression; but absent breath sounds + dullness implies a fluid/blood collection or complete collapse requiring chest tube insertion.