PneumothoraxCreated OnMay 4, 2020Last Updated OnOctober 26, 2020byadmin You are here: Main Radiology Pneumothorax < All Topics Table of Contents Radiographic features: Plain radiograph There is lucency (black) at the left upper zone. This is typical of pneumothorax. Take note of the thin, sharp white line inferior to the lucent region. This is the visible visceral pleural edge. Peripheral to this line there is no lung markings. Lung may completely collapse There is mediastinal shift in Tension pneumothorax. It is not present here. Look carefully for subcutaneous emphysema and pneumomediastinum as well, as they may also present. Tension pneumothorax NOT TO MISS! Radiolucent left hemithorax Signs of tension: Compression of left (arrowheads) Trachea and heart shifted to the right (arrow) Left hemidiaphragm is flattened. *IMPORTANT NOTE If you diagnosed a tension pneumothorax clinically – do not request an X-ray – TREAT THE PATIENT FIRST! Large Pneumothorax Size of a pneumothorax helps to determine management. Based on British Thoracic Society guidelines, a large pneumothorax is > 2 cm width at the level of the hilum as shown in this chest radiograph. Small Apical Pneumothorax Clinical features are considered besides size of pneumothorax. If a patient is breathless or has known lung disease, then interventional measures should be considered even if the pneumothorax is small. Iatrogenic pneumothorax Pneumothorax can be caused by medical procedures. Thoracentesis (pleural aspiration) was done for this patient with right pleural effusion. Post procedural radiograph shows dense opacification of the right lower zone – due to consolidation and a residual effusion (arrows) with pneumothorax (asterisks) at the right upper zone. In cases where these features are not clearly present several techniques can be employed: Lateral decubitus radiograph: should be done with the suspected side up Lucency would be expected at the side up with adjacent lung collapse. Ultrasound CT scan Ultrasound M-mode (motion mode) can determine movement of the lung. Small pneumothoraxes are best appreciated when patient lies supine position (gas rises) at the anterior chest wall. Large pneumothoraxes are best appreciated laterally in the mid-axillary line. M-mode of normal lung versus pneumothorax. CT Scan CT Thorax Axial View – Left Pneumothorax (Black area). Notice the same density compare to the air around the thorax. *Some of the image photo is taken from web, we do not own this, it’s for knowledge sharing purpose.
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