X-ray
Is the cause of this patient's chest pain evident on the study?
Yes. There is a left apical pneumothorax and air in the mediastinum.
Will this patient need further imaging?
This can be managed conservatively, as the connection is between sterile lung and mediastinum this should heal spontaneously without complication (unlike from oesophageal rupture).
Small left apical pneumothorax.
Subcutaneous emphysema (vertical lucent stripes into neck) and "double bronchial wall sign" suggesting pneumomediastinum. Small rim of air at AP window.