Large traumatic hemothorax
Motor car versus a pole at high speed.
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Note the generalized increased density to the right hemithorax and well-defined homogenous density laterally with a well-defined margin representing a supine distribution fluid meniscus. There is midline shift to the left due to mass effect in the right hemithorax. Multiple bilateral rib fractures are seen including fractures posteriorly and laterally on the right which may indicate a flail segment. Nasogastric tube and ETT are appropriately positioned. Attempted pneumocath insertion on the left has been unsuccessful with the catheter within the axilla soft-tissues. Bilateral apical capping is likely related to combination of extra-pleural hematoma from rib fractures and the hemothorax itself on the right. Pulmonary vascular markings are poorly seen on the right indicating pulmonary contusion. Lower volume pulmonary contusion is seen on the left.
Typical appearance of a sizeable right sided traumatic hemothorax on supine chest x-ray.
- moderate to large right hemothorax with mediastinal shift to the left
- pulmonary contusion, right lung greater than left
- multiple bilateral rib fractures with possible flail segment on the right
- left pneumothorax (pleural edge seen laterally and deep sulcus sign)
- left subcutaneous emphysema
- bilateral apical pleural capping due to combination of rib fracture related extra-pleural hematoma and supine tracking of hemothorax to the apex
- failed attempt at left pneumocath insertion