CXR Case 150

There is marked tracheal and mediastinal deviation to the left, reflecting collapse and volume loss of the left lower lobe.
There is a fracture of the 7th rib on the left side and a further fracture of the 7th rib on the right side.

* There are air bronchograms visible in the left mid zone suggesting consolidation
* There is a small left apical rim of air, probably a small pneumothorax

This lady may well require positive pressure…

Either NIV, mechanical ventilation or airway maneuvers from the physio to re-inflate the lung, which means that a CT would be indicated to establish if this is a pneumothorax

The pneumothorax is most likely from the rib fracture.

Secondary pneumothorax in the context of no (known) lung pathology prior is quite unusual.

*This may be a sign of underlying emphysema or necrosis of the visceral pleura