Deep sulcus sign - pneumothorax
50 years old male involved in motor vehicle accident.
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Deep sulcus sign demonstrated on the initial supine chest radiograph which is highly suggestive of a right sided pneumothorax. This was confirmed on an erect chest radiograph a day later.
Deep sulcus sign depicts pneumothorax in the supine position as air ascends to the non-dependent pleural space outlining the anterior costophrenic recess/sulcus. If the volume of pneumothorax is sufficient large it can also outline the the costocardic angle and the pericardial fat and additional "pericardial fat pad sign" may also be observed.
A prudent radiologist will need to asses the costophrenic and pericardial region closely when inspecting supine trauma and ICU radiographs as small pneumothorax can be a subtle finding.