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Up until this point, I've shown a number of examples of pneumothoraces on x-ray.

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I want to show now one on CT, just because you'll also see them in this setting.

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One thing I will point out is that, on your CT, you'll get a scout view.

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And don't be so quick to jump to the axial images or the coronal images.

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Take a look at the scout view.

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There's lots of information that is here.

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Oftentimes, it will very closely

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approximate what the radiograph looks like.

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And you'll be surprised at how much more

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information is gleaned on the CT versus the scout or the x-ray comparison.

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On this scout view, you can see very subtly that there is a pigtail catheter.

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So if we zoom in here, we'll see it a little bit better.

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But you can see it right along here, the pigtail catheter.

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So that's something we're going to be

0:51

on the lookout for. The heart and the mediastinum look, otherwise, normal.

0:56

Doesn't look like there's any evidence of tension.

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So let's take a look at the axial images now

1:01

and take a look at what we should expect to see.

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So again, scrolling through,

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we notice that there is an apical component of the pneumothorax here.

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So we see air here in the pleural space.

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We can get a sense of how big it is, and its entirety, scrolling all the way through.

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And this would be considered rather small.

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There's also a basilar component.

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There's a little bit of atelectatic change here at the base,

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but we then have a little new seal which may relate to an injury or a laceration.

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When we scroll through, just for completeness sake,

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on the left side, there may be a small pneumothorax along the left side as well.

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But certainly, the majority of the component is on the right side.

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Again, we talked about the pigtail catheter, which we see entering here.

1:57

We'll just blow that up in a moment.

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As you can see, the catheter tip is coming in right here.

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And while the pneumothorax is not very

2:07

large, it has not resolved with the insertion of the catheter.

2:11

So it may be that this is not optimally placed.

2:14

It looks like it's sitting here along a visual line.

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And we do see subsequent subcutaneous emphysema along the chest wall,

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which is an expected finding, and at the insertion point.

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So if you take a look, just to be complete, on our soft tissue windows,

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you can take a look at the thyroid, which appears normal.

2:38

We didn't give contrast, but we see the vascular structures,

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the great vessels, and in terms of the non contrast view, they look normal.

2:48

We're going to go down through a portion

2:49

of the abdomen and just make sure there's not anything abnormal there.

2:52

We do see the stomach with ingested material, some of which is high density.

2:58

You can see the kidneys,

3:00

the one on the right and the one on the left, portion of the spleen,

3:06

the liver and a portion of the gallbladder, and those look fine.

3:11

We'll reserve looking at the bones

3:13

for the coronal and the sagittal images, which will look at right now.

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And there's, again, information that's helpful to see there.

3:20

So one of the things I like about

3:21

the coronal view, particularly for CT, is that you can basically approximate what

3:27

your chest x-ray would have looked like, same orientation.

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And so when we look at the images here, if we're looking to similarly create

3:36

a measurement for the air gap, it's a lot easier to do on the coronal.

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And so we can measure apical air gap, approximately 1.8cm.

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You can also do a lateral air gap,

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which is about 1.3cm, to give the clinicians a sense of how large this is.

3:56

This one also has a basilar component, so you could equally measure things down

4:00

here at 2.2. So you can get those reference points.

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And certainly, if there's a question of whether or not this is functioning,

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if they're looking at it over time, it should be getting smaller.

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And if those numbers aren't changing,

4:11

then you could certainly address the question of whether or not the tube is

4:15

adequately placed and functioning.

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On this view, you can also take a look at the airways.

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So the trachea runs really nicely,

4:22

you can see its arborization and the smaller airways throughout.

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And then, a nice opportunity to look at the osseous structures,

4:32

the retrieval bodies, which are well aligned, the heights are maintained.

4:36

And again, taking a look at the ribs,

4:39

serving the setting of trauma, to see if there's any evidence of fracture.

4:43

The sternum here anteriorly,

4:46

which is also normal, as is the manubrium.

4:49

The clavicles look normal, the shoulder complex is also normal bilaterally.

4:56

And finally, on the sagittal view, again, great opportunity to look at,

5:02

and I like it for really looking at the spine,

5:06

looking at the alignment really nicely, the body heights,

5:09

the alignment of the facets, and taking a look at the sternum and the manubrium.

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This is particularly helpful in the setting of trauma.

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And now this is not a trauma case,

5:20

but it's always good to get in the habit of looking at all these structures each

5:23

and every time, because that way you won't miss it when you need it.

5:27

So this was a CT case of pneumothorax without any evidence of tension.