Presentation
Motorbike accident.
Patient Data
Radiopaedia's Trauma Radiology Course >> Video On-Demand
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.
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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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