69-year-old male fell from a tree…

April 22, 2012

Chest, Chest XR, Trauma, XR


69-year-old male fell from a tree

Contributor:  Russell Jones, MD

Date: 4/25/2012

This guy fell from a tree about 12 feet up…

Here is his Chest X-ray:

What is wrong with this picture?

Answer 

Pneumothorax!

On the right side of the radiograph subcutaneous air can be seen lateral to the chest wall. Subcutaneous air with no physical exam supporting a puncture or a laceration is highly suspicious of a pneumothorax. Other sources of subcutaneous air can be from tracheal or laryngeal injury but usually this is associated with large subcutaneous air tracking in the area of the neck (but can be extensive).

The radiograph, however, is indicative of a small pneumothorax. The right lung appears to be fully inflated and it doesn’t show a deep sulcus sign.

This guy was seen at a level I trauma center and thus trauma was notified and recommended a CT scan to look for concominant injuries. Specifically their concern was liver injury and multiple occult rib fractures. A CT of the chest and abdomen were ordered with IV contrast to evaluate for these injuries as well as to quantify the severity of the pneumothorax.

CT chest:

On the Chest CT under lung window a small anterior pneumothorax can be seen. Other findings included a small pulmonary contusion in the right lower lobe and 2 non-displaced rib fractures (7 and 8).

The question is…does this guy need a tube thoracostomy (chest tube)?

I’ll leave the management decisions up to you…

Advertisements
,

About emrems411

EMREMS: Radiology in Emergency Medicine

View all posts by emrems411

Subscribe to EMREMS

Subscribe to our RSS feed and social profiles to receive updates.

No comments yet.

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: