CXR of pneumothorax

Today we discussed with our final year senior, Kak Maliya and Dr. Shaiful Ehsan on few things...confined on the findings of 

1. abdominal X-ray findings in case of tuberculosis 

2. pneumothorax in chest X-ray

But maybe I'll make another entry on the TB later. It is very common so it is a SIN not to master the findings be it in history, physical examination or investigation for tuberculosis.

At first, Kak Maliya gave us a picture without giving us the diagnosis. So, how would you describe the findings in the picture given below? This picture is really good for educational purpose. But this is not from HTAA of course. She got it somewhere from journal or google.

So, let say, if a patient presented to A&E with shortness of breath after being stabbed on the chest. Describe the CXR given :

1. Trachea and mediastanal are displace, shifted away from the collapsed lung. Some might use the word pull or push, but that would be depending on the pathology. Like in this case, trachea and mediastanal are pushed or shifted away towards right from the collapsed side.

2. Visible visceral pleural edge. Usually, the parietal and visceral pleura are usually sliding against each other but they are too thin, making it looks like a single layer. But as the air enter in between, making the gap larger, the visceral pleural edge should be appreciated in pneumothorax. 

3. Look at the bones as well! Sometimes fracture may cause pneumothorax if it pokes the pleura. The ribs, sternum, clavicle should be symmetrical. There are ways to look if they are symmetrical by using spinous process of vertebrae as referred point.

4. In this picture, the costophrenic angle is sharp. If it is blunted,

5. Clear cardia border. Sometimes, if there is consolidation particularly at the base, it is hard to look at the cardiac border as the opacity of lung will increase.

6. Vascular marking is absent beyond the visceral pleura edge making it relatively more radioluscent. Of course lah absent, lung dah collapsed.

7. If breast shadow is not seen, so the patient should be male or...or female with history of mastectomy. But, you don't have to mention it. But good to know:) 

If theres is fluid, air fluid level should be seen. 

There are few pdf files I got from my lecturer in radiology class back in BMS which are really useful. Leave me your email if you want. We gotta see more chest X-rays radiography, to get used to the radiography images. Good Luck! 

May Allah ease.