Upcoming Events
Log In
Pricing
Free Trial

Case 1 - Pneumothorax on Chest X-ray

HIDE
PrevNext

0:01

This is the case of a 35-year-old man

0:03

who is complaining of chest pain.

0:06

What I like to do when I encounter chest X-rays, which you'll see lots

0:09

of in the emergency room, is to create a checklist of doing the same

0:13

thing every single time, in every single instance.

0:17

How you do it may differ from

0:18

how I do it, but what I encourage you to do is to find a way and stick to it.

0:23

In that way, you don't forget anything.

0:25

So what I like to do is first to take a look at the lung fields.

0:29

I'm looking for any sorts of nodules.

0:31

Any sorts of plural effusions, airspace consolidation, masses, pneumothoraces.

0:37

I'll take a look at the heart and the mediastinum,

0:40

paying attention to the airway as well.

0:43

We'll look at the bones and the

0:44

soft tissues as we move kind of

0:47

out of the periphery of the examination.

0:50

So in this exam, when I look

0:51

at the left lung field,

0:53

normal lung markings, and everything here looks normal, well expanded.

0:57

There's no focal consolidation, pleural effusion.

1:00

When I come to the right side, and it's a little difficult to see,

1:05

but when you magnify, you can see really nicely, the pleural line that's sitting here.

1:13

Not at the edge of the thorax, but this is a pneumothorax.

1:18

What I like to do with pneumothoraces

1:21

is to give clinicians information that they can use.

1:23

And so what that involves is measuring the air gap.

1:28

And so we'll measure here an apical

1:30

air gap, which is approximately 6cm.

1:34

I'll also provide a lateral air gap,

1:38

which is about 3.4cm. And so, we also want to make sure that with pneumothoraces,

1:45

we're giving clinicians additional information that they can work with.

1:49

And so the big thing we want

1:50

to mention is, is there any evidence of tension?

1:53

And so for tension,

1:54

we're looking for shift of the mediastinum structure, so the airway or the heart

1:59

and mediastinum, away from or in the opposite side of where the pneumothorax is.

2:04

So for a right sided pneumothorax,

2:06

we would expect to see things shifting to the left if there was tension.

2:11

And here we can see that the airway is

2:12

still pretty well aligned with the midline spinal structures.

2:16

We also can look at the distance

2:18

between the ribs and there they look

2:20

pretty symmetric on both sides.

2:22

There is no evidence of tension.

2:24

However, we do have a large right sided pneumothorax.

Report

Faculty

Jamlik-Omari Johnson, MD, FASER

Chair, Department of Radiology

University of Southern California

Tags

X-Ray (Plain Films)

Trauma

Syndromes

Pleural

Lungs

Infectious

Idiopathic

Iatrogenic

Emergency

Chest

© 2024 Medality. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy