Spontaneous Right Pneumothorax Manifesting as ST-Segment Elevation on ECG

BACKGROUND: Electrocardiographic (ECG) findings in right-sided pneumothorax are clinically variable. This case details ECG changes characterized by ST-segment elevation in the high lateral leads, offering insights for clinical management, diagnosis, and treatment. CASE SUMMARY: A 63-year-old woman with spontaneous pneumothorax was admitted with severe cough and chest tightness. Her ECG revealed ST-segment elevation in leads I and aVL. Cardiogenic causes were excluded after further examination, attributing the symptoms to right-sided pneumothorax. The ECG normalized after the pneumothorax was resolved. DISCUSSION: The ECG manifestations of right-sided pneumothorax are less clinically apparent compared with those of left-sided pneumothorax. This phenomenon is underpinned by multiple mechanisms, necessitating the integration of observed ECG findings to accurately localize the affected site and perform a comprehensive analysis. TAKE-HOME MESSAGES: The mechanism underlying right-sided pneumothorax is complex, with diverse clinical manifestations. Analyzing its etiology and tailoring treatment to the specific clinical context is essential.