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Sick stethoscope syndrome.

To the Editor.— Spontaneous pneumothorax can be clinically diagnosed by absent unilateral breath sounds along with other physical signs. We report a case of an apparently shifting spontaneous pneumothorax in a previously healthy man. Report of a Case.— A heavyset 38-year-old man presented to the emergency department with pleuritic leftsided anterior chest pain of four hours' duration. He was receiving no medicines and had no previous history of cardiac or lung disease. The patient's respiratory rate was mildly increased, but there was no cyanosis. Cardiac auscultation, with the examiner on the patient's right side, revealed no breath sounds on the left side. A provisional diagnosis of spontaneous pneumothorax was made. He was given 3 L/min of oxygen by nasal prongs, and a chest roentgenogram was taken. It was normal, so the patient was examined again: this time, no breath sounds were heard on the right side, but they were well