This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. 50 year old male presents with shortness of breath after being hit in the left upper chest, concerned for pneumothorax. The patient in this case presented with this AP radiograph demonstrating a left apical pneumothorax. Here we can see that the lung markings in the left lung apex is no longer visualized, consistent with a small pneumothorax. The patient did undergo CT of the chest. Here is her axial lung window demonstrating the small pneumothorax in the left lung apex correlating to findings seen in prior radiograph. CT is not routinely done in patients with pneumothorax. However, it could be of assistance in determining the source of the pneumothorax. Here is in a different patient. The first modality used for evaluation of pneumothorax is a chest radiograph. We can see a visible, visceral, plural edge as a very thin white line with no lung markings peripheral to this line. This is consistent with a pneumothorax. We measure the pneumothorax from the maximum apical to interplural distance and staying consistent on every follow-up. Additional things that we evaluate in patients with pneumothorax is the status of the lung parenchyma, which may be totally collapsed, but not in this case. We evaluate the mediastinum, such as here, and it should not shift away from the pneumothorax unless there is tension pneumothorax. Tension pneumothorax is an emergency.

2nd Edition, CASE 41

2nd Edition

Pulmonary