Pneumothorax with deep sulcus sign

Case contributed by Andrew Dixon
Diagnosis certain

Presentation

Chest x-ray post emergency trauma laparotomy.

Patient Data

Age: 35 years
Gender: Male

Chest x-ray

x-ray

Multiple displaced right sided rib fractures. Patchy increased density in the right hemithorax is probably due to pulmonary contusion. Despite presence of a right sided intercostal catheter, there is evidence of a sizable residual right pneumothorax with a deep sulcus sign. Packing is seen in the left and right upper quadrants of the abdomen related to the trauma laparotomy. ETT and NGT in situ. 

Subsequent chest x-ray

x-ray

Resolution of the deep sulcus on subsequent chest x-ray. Presumably the ICC was adjusted or placed on suction to assist drainage. 

Case Discussion

An example of the deep sulcus sign of pneumothorax in a supine patient. This is an important chest x-ray sign, as a large volume of pneumothorax may be present in supine patients without a pleural edge being visible. 

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