While riding mountain bikes during Thanksgiving vacation, John hits a rock and is thrown against his handlebars. You see that the major force of the impact was to his chest. Upon performing a survey examination, you find that there is a severe soft tissue injury to the chest over the right 4th rib. Breathing is painful but John insits that he can make it back home. That afternoon, you notice that John exhibits some signs of cyanosis (blue fingernails and lips) as well as rapid respiration and you take him to the hospital. The ER resident percusses the chest and you hear a hyper-resonant sound when the chest is percussed over the 6th intercostal space on the right side. John was then sent to radiology where a chest film was taken on full inspiration. You get a peek at the film as the technician is taking it back to the ER and notice that the right pleural cavity is darker than the left and that the mediastinum and trachea are both deviating to the left. Waiting for the resident to return, John asks for your thoughts on what her diagnosis is likely to be.