skip to Main Content

Radiology Image: A 29-year-old male

A 29-year-old male

[headline_subtitle title=”” subtitle=”Can you solve the radiology image of this edition?”]
Patient data
  • Age: 29
  • Gender: Male
  • Medical history: None
  • Initial presentation: Dyspnoea, pain in right side of chest, saturation 80%, bulging neck veins, no breath sounds at the right side of chest, right side of the chest more convex.

X-thorax

X-thorax

X-thorax

X-thorax

Question about the X-thorax.

S. Spijkers & M. Maas

Checklist Röntgen (Thorax)

  1. Mediastinum: should be symmetric and biconcave.
  2. Trachea: should be in the center of the mediastinum.
  3. Hilum: evaluate lymph nodes.
  4. Heart: heart-thorax ratio should be ≤0.5.
  5. Vessels: should be delicate.
  6. Lung fields: check for infiltrates + evaluate sinus pleurae for pneumothorax.
  7. Diaphragm: should be easily distinguishable.
  8. Bones: ribs, sternum, clavicles, scapulae, vertebrae.
  9. Soft tissues: check for foreign bodies.
[large_separator]

Primary pneumothorax can be recognized in thorax x-rays by:

  • visible visceral pleural edge see as a very thin, sharp white line
  • no lung markings are seen peripheral to this line
  • the peripheral space is radiolucent compared to adjacent lung
  • the lung may completely collapse

Primary pneumothorax occurs mostly in younger (<35) patients. Whereas tension pneumothorax can be lethal, with constantly enlarging pressure on the mediastinum, a primary pneumothorax usually is not.

At the initial presentation a needle aspiration is done if the pneumothorax is quite severe or if it may be a tension pneumothorax. Needle aspiration gives immediate relief on the pressure inside the thorax. In a small rim pneumothorax (<2 cm), this is not necessary, see the literature. Surgery is only necessary if the pneumothorax is recurring as they can attach the lung to the chest wall.

X-thorax of pneumothorax

X-thorax of pneumothorax

X-thorax of pneumothorax

X-thorax of pneumothorax

  1. Emedicine.medscape.com,. (2016). Pneumothorax: Practice Essentials, Background, Anatomy. Retrieved 12 January 2016, Available here
  2. Gorrochategui, M. (2016). Pneumothorax | Radiology Reference Article | Radiopaedia.org.Radiopaedia.org. Retrieved 12 January 2016, Available here
  3. Gaillard, F. (2016). Tension pneumothorax | Radiology Reference Article | Radiopaedia.org.Radiopaedia.org. Retrieved 12 January 2016, Available here
  4. Planner, A., Misra, R., & Uthappa, M. (2007). A-Z of chest radiology. Cambridge: Cambridge University Press.

Leave a Reply

Your email address will not be published. Required fields are marked *

Back To Top