Chest X-Ray breakdown: assessing a pneumothorax

A male in his 50s presents with acute breathlessness. What does the X-Ray show?

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HYDROPNEUMOTHORAX AND RIGHT LUNG OPACITIES
👨🏽‍💻Another tricky X-Ray! There is a lot going on on this X-Ray and so it shows the importance of a systematic approach. Firstly there is a hydropneumothorax: we can see gas in the pleural space evidenced by a lack of lung markings and pleural line. At the right lung base we can see a gas-fluid line (a sharp horizontal line) meaning there is also fluid within the pleural space - we can term this a ‘hydropneumothorax’.

👨🏽‍💻We can see two opacities within the right lung: one is more obvious than the other. A second ‘hidden’ lesion can be seen ‘through’ the hilum. Although this looked spiculated on CT, this resolved on a follow up scan meaning we can say both were benign and likely caused by an infection. In terms of aetiology of the pneumothorax, this is likely either secondary to the pneumonia or rupture of a bulla/bleb given the patient’s emphysema.

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☑️Patient consent obtained
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[D]

Excellent presentation. Short, clear explanations and good follow up images and teaching points. Thank you so much!

[minhtantran]

Thank you so much for an amazing case!

[JuanVasquez]

I was waiting for the explanation on the vieling of the right costophrenic angle