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Deep sulcus sign of pneumothorax

Case contributed by Garth Kruger
Diagnosis certain

Presentation

Chest discomfort for 2 weeks.

Patient Data

Age: 16
Gender: Male
x-ray

The frontal chest view shows a left pneumothorax. Note the deep sulcus on the left. 

Annotated image

Annotated image

The annoted image shows the visceral pleura with air under the left lung.

Case Discussion

The deep sulcus sign was originally attributed to the classic supine chest x-ray projection.

In this case the patient was mobile and the x-ray is erect. The air under the lung gives rise to the "deep sulcus". It's a handy way to catch your eye and draw attention to the subtle pneumothorax.

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