This week's free board review question...
A 54-year-old man is involved in a moderate-speed motor vehicle collision. Upon evaluation, you find that he has several rib fractures, but he has no evidence of pneumothorax, hemothorax, or flail chest (clinically or via plain x-ray). You prescribe him oxygen as well as medication to relieve his pain; you also decide to admit him for observation.
Approximately 8 hours after the incidence, he begins to complain of worsening chest pain and becomes progressively tachypneic, tachycardic, and hypoxic. He requires intubation and mechanical ventilation.
Computed tomography (CT) is urgently obtained (see Figure).
Which of the following is the most likely cause of respiratory failure in this patient?
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