35 year old male represents with shortness of breath 5 days after falling of his bicycle. His initial chest x-ray on day one had shown a tiny pneumothorax and several rib fractures.
Left Chest: Upper anterior
View 2 – Right Chest: Upper anterior
View 3 – Left Chest: Posterolateral
View 4 – Left Chest: Posterolateral
View 5 – Left Chest: Posterolateral
Describe and interpret these scans
Image 2: Normal lung sliding and comet tail artefact on the asymptomatic side.
Image 3: Pleural effusion with underlying collapsed lung
Image 4: Pleural effusion with collapsed lung, but now an air fluid level is seen descending on inspiration.
Image 5: Linear transducer shows the curved diaphragm moving with inspiration. There is an air fluid level of the haemopneumothorax.
A pneumothorax is rapidly detected, as is the basal pleural effusion.
The air fluid level is often confused with a lung point, but rather than the dynamic point of separation between the parietal and visceral pleural surfaces that is the lung point, this is the site of the junction between air and fluid in a hydropneumothorax.
Dependent fluid with air above it. The collapsed lung can be seen through the pleural fluid.