CXR Case 126
A 55 year old man lost control while cycling ~20km/hr – and strikes a sign post. On arrival to ED he is complaining pain down left side of his torso.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is a fracture of the 2nd rib on the left and lost of the left costophrenic angle consistent with a small haemothorax.
The mid-portion of the left scapula may have a fracture in addition.
CLINICAL CORRELATION
The cervical spine will need protection and imaging given the severity of trauma above the clavicle.
A small haemothorax such as this can become a big haemothorax – close clinical observation, evaluation with ultrasound, contrast CT and highly likely a chest drain are required.
CLINICAL PEARLS
Massive haemothorax is one of the six potentially life threatening causes of thoracic trauma
Initial blood loss of >1500mLs or >200mL/hr for 2-4 hours is an indication for thoracotomy.
TOP 150 CXR SERIES
Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar | ICIS Course ANZ