A 41 year old male has shortness of breath and a contusion to the sternum after being kicked by a horse. What should you suspect?

In this scenario, the presence of a sternum contusion after a direct traumatic event, such as being kicked by a horse, raises the suspicion for cardiac tamponade. This condition occurs when fluid accumulates in the pericardial space, leading to pressure on the heart and impairing its ability to pump effectively. The mechanism of injury, combined with the patient's shortness of breath, aligns well with the signs and symptoms associated with cardiac tamponade, such as hypotension, tachycardia, and respiratory distress.

The blunt trauma to the chest can cause bleeding into the pericardial space, leading to an accumulation of blood or fluid. The classic presentation may include the triad of hypotension, muffled heart sounds, and jugular venous distention—also known as Beck’s triad. However, even without all of these signs, the shortness of breath and traumatic history significantly point toward this life-threatening condition that requires immediate medical attention.

Other options such as congestive heart failure, pulmonary embolism, and pulmonary edema could present with shortness of breath but do not closely correspond with the context of blunt chest trauma and an associated contusion to the sternum, making them less likely.