The Chest X-Ray Database
The Chest X-Ray Database
This case demonstrates both a right pneumothorax and pneumopericardium. In this case, the cause was iatrogenic during a bronchoscopy. A right chest tube is in place, though a small apical pneumothorax is still visible.
Clamshell sternotomy closure hardware is also seen, indicating that this is a lung transplant patient.
This radiograph demonstrates a left subpulmonic pneumothorax in the upright position. Typically pleural air would be expected to collect apically (anti-dependently) in this position. However, this patient has a history of wedge resection evident by the staple line seen in the apical left upper lobe. This was complicated by recurrent pneumothorax for which the patient underwent pleurodesis. The resultant pleural scarring is preventing the pleural air from rising, giving this appearance.
Other than the presence of EKG leads, the remainder of the exam is unremarkable.
This radiograph demonstrates a right pneumothorax without evidence of tension physiology. This case was iatrogenic due to an inadvertently damaged diaphragm during an abdominal surgery. Linear subsegmental atelectasis is also noted projecting over the left heart.
This radiograph demonstrates a left pneumothorax without evidence of tension physiology. This was a spontaneous pneumothorax in a young patient, unknown etiology.
This radiograph demonstrates a skin fold projecting over the right hemithorax that could be easily mistaken for a pneumothorax. Skin folds are frequently identified as such because they cross anatomic boundaries such as the mediastinum or lateral chest wall. The lack of clinical symptoms such as shortness of breath can be reassuring, but not definitive. In this case, the only imaging finding that distinguishes the skin fold from a pneumothorax is the minor fissure which remains intact across the pseudo-pleural separation. A repeat chest radiograph was obtained with instruction to the technologist to smooth the patient’s skin and clothing prior to acquisition and the finding was no longer present. A left lateral decubitus radiograph would have also been an appropriate next step.