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Bilateral pneumothoraces with deep sulcus sign

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Acute severe shortness of breath. No trauma.

Patient Data

Age: 40 years
Gender: Male

Both the extreme apices and costophrenic angles are excluded from the image.

Large bilateral pneumothoraces. 

Although the costophrenic angles are excluded from the image, the deep sulcus sign is evident bilaterally.

The lungs are collapsed.

Case Discussion

Large nontraumatic bilateral pneumothoraces are uncommon.  No mediastinal shift is evident as the bilateral pneumothoraces equilibrate any shift.

The chest cannot be totally covered on the image, but the supine projection indicates bilateral deep sulci, a typical feature in this projection.

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