Deep sulcus sign - supine pneumothorax

Case contributed by Dr M Sanal Kumar


Breathing difficulty

Patient Data

Age: 49
Gender: Male

Left sided pneumothorax in supine projection seen as deep sulcus sign.

Case Discussion

Pneumothorax on an erect chest radiograph is easy to diagnose, but on supine films it is difficult because air in the pleural cavity takes a non dependent position.

Signs of pneumothorax on supine radiographs are:

  • deep sulcus sign: air in the pleural cavity collects in the anterolateral pleural space outlining the deep costophrenic angle
  • increased clarity or sharpness of the ipsilateral hemidiaphragm
  • double diaphragm sign
  • increased sharpness of the mediastinal or cardiac outline
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Case information

rID: 36707
Published: 5th May 2015
Last edited: 2nd Sep 2019
System: Chest
Inclusion in quiz mode: Included

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