A 34-year-old man was brought to our emergency department with an anterior chest wall blunt injury in a bicycle-to-curb accident at a speed of 35 mph. His anterior chest hit the concrete with a direct frontal impact. He complained of severe left upper anterior chest wall pain, which was aggravated by rotation of his body. The physical examination disclosed severe tenderness of the left anterior chest wall. He had no subcutaneous emphysema or decreased breathing sounds. A chest radiograph showed normal findings. We administered an intravenous analgesic agent, but his pain decreased only slightly. Owing to the patient's out-of-proportion pain in relationship to his physical and radiographic findings, we re-evaluated the patient using the expiration-inspiration (E-I) test, which is done by a physician who stands behind the patient who sits in a chair
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