CXR Case 130
A 31 year old builder falls approximately 2m onto a concrete block. He attends the emergency department complaining of severe right sided chest pain.
AP CXR 
CT Recon
click images to enlarge
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
CXR Interpretation:
There are fractures to the right 7th and 8th ribs.
Right sided pneumothorax with increased parenchymal infiltrates right lower zone. Pleura look clear.
Surgical emphysema over right lateral chest. Left side normal.
CT scan Interpretation:
CT reconstructed images demonstrate the posterolateral rib fractures. No evidence of a flail segment.
CLINICAL CORRELATION
The increased parenchymal infiltrates likely represent pulmonary contusion.
Very close observation for increasing respiratory distress is required, with ~10-15% of cases with pulmonary contusion requiring mechanical ventilation
The traumatic pneumothorax requires a chest tube.
CLINICAL PEARLS
There is no specific therapy for pulmonary contusion.
Supportive care with careful fluid resuscitation (avoiding prolonged hypovolaemia precipitating cytokine and inflammatory cascade activation causing pulmonary oedema, and further avoiding over-filling, causing pulmonary oedema) and oxygen for correction of hypoxaemia will be required.
Analgesia is key to facilitate adequate ventilation.
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