Case contributed by Dr Andrew Dixon


Motorbike accident.

Patient Data

Age: 50
Gender: Male

Trauma Radiology Course  Edinburgh June 11  |  Melbourne July 9  |  Video On-Demand August 1

Chest X-ray

Modality: X-ray

Generally increased density of the right hemithorax compared to the left in a supine trauma patient. This is highly suspicious for a right sided haemothorax especially given the film does not appear rotated. No other definite signs of trauma are seen. 

CT Chest

Modality: CT

Bilateral haemothorax, right greater than left, accounting for the density difference seen on the supine chest x-ray. Mild atelectasis is seen adjacent to the haemothoraces and likely small volume pulmonary contusion in the right lung base where a small traumatic pneumatocele is seen. Subtle inward angulation of multiple anterobasal ribs are consistent with incomplete fractures. A right T10 transverse process fracture was better appreciated on sagittal images and a fracture of the right superior aspect of the T10 vertebral body. Locules of soft-tissue gas are seen near the T10 injury and also near the rib fractures. Trace bilateral pneumothorax is seen anterobasally.  

Case Discussion

This case is a nice example of a supine haemothorax on a trauma chest radiograph being identifiable as a generalised increase in hemithorax density compared to the contralateral side.  

CT Findings

  • Bilateral haemothorax, right greater than left
  • mild atelectasis adjacent to the haemothoraces
  • small pulmonary contusion and traumatic pneumatocele right lung base
  • multiple bilateral anterobasal incomplete rib fractures
  • right T10 transverse process and vertebral body fracture with adjacent locules of gas
  • trace bilateral pneumothorax anterobasally (very tiny!) 
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Case Information

rID: 31522
Case created: 14th Oct 2014
Last edited: 23rd Apr 2016
Systems: Chest, Trauma
Inclusion in quiz mode: Included

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