Case 1002
Left pneumothoraxWhat is the diagnosis?
X-ray
1 / 1
Frontal chest radiograph. Look carefully at the periphery of the left hemithorax.
Image: Clinical Cases, CC BY-SA 2.5 — sourceAnswer hidden. Review the images and history, decide on your diagnosis, then reveal.
Findings
- A thin visceral pleural line runs down the left hemithorax, with no lung markings lateral to it
- The left lung is partially collapsed towards the hilum; the peripheral left hemithorax is hyperlucent
- No convincing mediastinal shift on this film
- Patchy opacity in the right lung; ECG electrodes overlie the chest
Case discussion
A large left pneumothorax. The key sign is the visceral pleural edge with absent markings beyond it — trace the pleura from apex to base on every film.
Tension pneumothorax is a clinical diagnosis: hypotension, hypoxia and a deviated trachea call for immediate decompression without waiting for imaging. Radiographic clues to tension include contralateral mediastinal shift, a depressed hemidiaphragm and widened rib spaces; they are not clearly present here.
Encyclopedia
Chest radiograph: systematic reviewA structured way to read every chest radiograph, from technical quality to review areas, so that subtle findings are not missed.PneumothoraxAir in the pleural space, separating the visceral and parietal pleura and allowing the lung to collapse away from the chest wall.
