The correct answer is C. This patient's exam shows evidence of chest wall trauma and decreased breath sounds. There is concern for a pneumothorax. Often, small pneumothoraces can be difficult to see on routine chest radiography. A chest radiograph at maximal expiration, by collapsing the lungs to a small volume, will increase the opportunity to visualize a pneumothorax.
An abdominal computerized tomogram (choice A) is not indicated in this patient at this juncture given her benign abdominal exam.
A chest radiograph at maximal inspiration (choice B), by inflating the lungs to the maximum, will not assist in the diagnosis of a pneumothorax.
An echocardiogram (choice D) can be used to diagnose cardiac or aortic pathology in the setting of a motor vehicle accident as with this patient. However, given the available information including the hemodynamic data, there is no reason to suspect such pathology here.
A ventilation-perfusion scan (choice E) is used in the diagnosis of a pulmonary embolus. There is no evidence that this patient has this pathology.
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