Case contributed by Andrew Dixon


Motorbike accident.

Patient Data

Age: 50
Gender: Male

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Chest 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 hemothorax especially given the film does not appear rotated. No other definite signs of trauma are seen. 

CT Chest


Bilateral hemothorax, right greater than left, accounting for the density difference seen on the supine chest x-ray. Mild atelectasis is seen adjacent to the hemothoraces 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 hemothorax on a trauma chest radiograph being identifiable as a generalized increase in hemithorax density compared to the contralateral side.  

CT Findings

  • Bilateral hemothorax, right greater than left
  • mild atelectasis adjacent to the hemothoraces
  • 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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