|PA chest x-ray. Click on image to enlarge.|
|Left rib x-ray|
|Oblique left rib x-ray.|
Red arrows denote the two rib fractures. Orange arrows, subcutaneous air. Green arrow, small apical pneumothorax.
The rib fractures and subcutaneous air are pretty easy to identify. Finding the pneumothorax is a little more difficult but here are a couple tricks to picking it up.
- Blunt (not penetrating) trauma + rib fracture + subcutaneous air = pneumothorax. Find it.
- First place to look for a pneumothorax on an upright chest x-ray is in the upper hemithorax as air in the pleural space will rise. Most common appearance is an area adjacent to the ribs where no lung vascularity is seen and where a very thin white line represents the visceral pleura.
Mettler: Essentials of Radiology, 2nd ed.