Presentation
Known case of Marfan syndrome presented with right shoulder pain. No history of trauma.
Patient Data
Classic appearances of right-sided pneumothorax with a readily apparent visceral pleural line.
In the fontal chest radiographic image diagnosis of right-side pneumothorax, the visceral pleural line is seen without distal lung markings.
A large-bore chest drain satisfactorily placed.
Case Discussion
This case came to causality by right shoulder pain and a shoulder radiograph was performed. 5 days later they presented with chest pain and it was an incidental diagnosis of a large right pneumothorax.
The correct interpretation of radiograph and knowledge of when to request more complex imaging techniques are essential.
The radiographic diagnosis of pneumothorax is usually straightforward - a visceral pleural line is seen without distal lung markings.
The British Thoracic Society guidelines divide pneumothoraces into small and large based on the distance from the visceral pleural surface (lung edge) to the chest wall, with less than 2 cm being small and more than 2 cm large. A large pneumothorax is an objective indication of drainage.
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