Junior call case 7

Left pneumothorax. No significant tension.

In ICU patients, the two findings to always consider carefully are pneumothorax and improperly positioned lines.

Being aware of the positioning of patient is crucial for identifying pneumothoraces. For upright patients, air will collect in the non-dependent apex of the lung. For supine patients, air will often collect in the most non-dependent portion of the supine lung – the costophrenic angle with the “deep sulcus sign” (asymmetric lucency in the costophrenic angle). Semi-upright positioning is tricky, because the location of the abnormal lucency is dependent on the degree of “semi-uprightness”.

• Whenever you identify a pneumothorax, ALWAYS look for evidence of tension – an ICU emergency.

Clues that support pneumothorax over skin fold:

o ↑ lucency in the peripheral regions and ↑ density in the central regions.

o Lung markings stop at the pneumothorax margin.

o Dense visceral pleural line at the pneumothorax margin (vs. lucent skin fold margin

Accession: CL0750

Study description: DX CHEST 1V