Presentation
ICU patient.
Patient Data
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ETT tip is projected in the proximal right main bronchus. NGT and left jugular CVL are well positioned.
Left deep sulcus sign and pericardial fat tag sign indicating a pneumothorax. Allowing for patient rotation, no signs of mediastinal shift.
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Pneumothorax confirmed on the left, with tags of pericardial fat at the cardiac apex hanging posteriorly. No mediastinal shift. Dependant LLL atelectasis.
Case Discussion
The pericardial fat pad sign is a nice but rare sign of pneumothorax on supine CXR. The pericardial fat displaces laterally as the lung is no longer adjacent to it pushing it against the mediastinum, hence causing a lumpy appearance of the cardiac borders.
Case courtesy of Dr Nivene Saad.