This case demonstrates a tension pneumothorax and post-intercostal catheter severe subcutaneous emphysema. The patient was successfully managed with two intercostal catheters on suction and a short stay in the intensive care unit followed by a period of close observation on the ward.

The Ginkgo leaf sign is radiologically apparent when there is severe subcutaneous emphysema of the chest wall, resulting in the striations of the pectoralis major muscle being well defined by adjacent air.

Case courtesy of Dr Drusilla Poiner, The Prince Charles Hospital, Queensland, Australia.