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.

CXR CASE 126 CXR LITFL

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 |

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