This young woman was playing rugby with “the boys” when she fell on one of the other player’s bent knee. She has pleuritic chest pain and palpable tenderness along the right chest wall anterior axillary line below the armpit (right about where you’d put a chest tube…hint…hint).
This case demonstrates the power of knowing what you are looking for. As you probably noticed she has a small, subtle pneumothorax best seen between ribs 3 and 4:
Its always a good idea to take the time when you are ordering radiology studies to help out your radiology friends and describe the area of concern and what you are looking for. This can help them identify subtle findings such as this small pneumothorax.
The patient was treated with supportive care, observed over night, and discharged the next day after a repeat chest xray showing no significant progression.
Author: Russell Jones, MD