Apical pneumothorax

Case contributed by Dr Derek Smith


History of COPD. Increasing breathlessness over a week, woke with worsening breathlessness.

Patient Data

Age: 65 years
Gender: Female

Hyperinflated lungs with upper and mid-zone emphysema.

Small bilateral pleural effusions.

Small right apical pneumothorax.

The heart is enlarged with evidence of pulmonary congestion.

No displaced rib fractures.

Acute deterioration in saturations. Increased work of breathing.


The right hemithorax is increased in lucency compared to the left, with little technical rotation.

The apical pneumothorax is not well visualized, however there is air adjacent to the right paratracheal stripe.

A small volume of subcutaneous emphsyema is also present.


Right-sided intercostal tube, oriented apically, has been placed for decompression of the pneumothorax.

Marked increase in the volume of subcutaneous emphysema.

Case Discussion

This case is important to remind you to examine the "never-miss" areas of the radiograph, in this case the apex.

The patient required an emergency chest drain as the small pneumothorax was not detected by the clinical staff until the patient deteriorated further.

In the absence of trauma, bullous disease is the most likely root of the pneumothorax, especially in patients with underlying emphysema or asthma.

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Case information

rID: 42217
Published: 11th Jan 2016
Last edited: 21st Jan 2020
System: Chest
Inclusion in quiz mode: Included

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