• The presence of air within the pleural space,

is one of the more common forms of thoracic

disease

Pneumothora • It is caused most often by trauma, either

x accidental or iatrogenic.

• In absence of such history, it is referred to as

spontaneous
• Spontaneous pneumothorax: Primary or
Secondary

• Primary: unassociated with clinical or

radiographic evidence of significant
pulmonary disease

• Secondary: in which significant pulmonary

disease is present
- Multifactorial pathogenesis
- MC in patients chronic obstructive
pulmonary disease (COPD)
 • UPRIGHT

- radiologic diagnosis of pneumothorax can

Radiologic be made only after identifying the visceral
pleural line
Findings - pneumothorax is first evident near the
apex of the chest
- visceral pleural line is usually readily
identifiable
 • If there is a strong suspicion clinically but
the pleural line is not identified, gas in the
pleural space can be detected by one of
the two procedures
Radiologic
Findings (1) Radiography in the erect position in full
expiration

(2) Radiography in the lateral decubitus

position with a horizonal x-ray beam
 • SUPINE
- gas within the pleural space rises to the vicinity
of the diaphragm, the highest point in the
hemithorax in this position.

Radiologic -Depending on the size:

Findings • result can be an exceptionally deep radiolucent
costophrenic sulcus (deep sulcus sign)
• a lucency over the left or right upper quadrant
• much sharper than normal hemidiaphragm
with or without the presence of visceral pleural
line
• Right pneumothorax
• Portable AP supine

• (+) Deep Sulcus Sign

Hemothorax
• Hemothorax is the presence of blood within the pleural cavity and is
most frequently caused by blunt or penetrating trauma.

• The diagnosis is made on plain upright chest radiograph by the

visualization of fluid (blood) collecting in the right or left hemithorax
causing:
- blunting of the costophrenic angle
- larger hemithoraces: layering out of the blood occupying a portion of
the hemithorax
• Blood may also be seen tracking up the pleural margins of the chest
wall on radiographs

• Associated injuries such as rib fractures, pulmonary contusions, and

pneumothorax are common in the presence of hemothorax.