CXR Case 145
Motor vehicle accident, driver of car vs. tree. Male. Severe respiratory distress on scene – presumed tension pneumothorax on left decompressed with a 14G cannula and intubated on scene.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
The tip of the ET tube is in the right main bronchus.
There is a large bore chest drain on the left side, the tip appears to sit in the medial costophrenic angle.
NG tube correctly placed.
No pneumothorax visible, lung parenchyma look normal.
There may be a thin rim of air under the left hemidiaphragm – a supine film or CT is required.
The apices of the lungs are not properly visualized.
CLINICAL CORRELATION
The ETT needs pulling back.
The chest drain does not necessarily require re-positioning – the pleural space is in continuity, it won’t drain air there, but will if there is a further tension.
CLINICAL PEARLS
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