Large left pneumothorax with mediastinal shift to the right. Note the collapsed left lung (arrows) and the hyperlucent left hemithorax.(1) The radiological abnormality that can be identified :
- Hyperlucent zone devoid of vascular marking in periphery of left hemithorax.
- Shift of midline to the right.
(2) So; the most likely diagnosis is left tension pneumothorax
Note the radiological features of tension pneumothorax seen in this
- Contralateral mediastinal shift
- Depression of ipsilateral hemidiaphragm
- Compressive atelectasis of adjacent normal lung
All of the above radiological signs indicate the presence of significant increased intra-thoracic pressure in tension pneumothorax which necessitates urgent treatment.
Notes:* The diagnosis of pneumothorax is confirmed by erect chest radiograph in full expiration.
* The absence of vascular markings in the periphery of the left hemithorax is due to air in the pleural cavity and not in the lung.
* Role of imaging in patients with pneumothorax:
1. Confi rm the clinical diagnosis
2. Assess extent of pneumothorax
3. Detect signs of tension pneumothorax
4. Follow-up examination to monitor resolution of pneumothorax after drainage