Post by @onthewardsco

Pneumothorax on chest X-ray can be easy to miss, especially when it’s small or the patient is supine. Here’s a quick framework for how to spot a pneumo on CXR before your attending does. 🩻 Look for a visible visceral pleural line, absence of lung markings peripheral to that line, and increased peripheral lucency. In supine patients, remember that pleural air can collect anteriorly and basally, so the classic apical pleural line may be absent and the deep sulcus sign may be your clue. Always check for tension physiology too. On CXR that can include a large pneumothorax, mediastinal shift away from the affected side, and depression or flattening of the ipsilateral hemidiaphragm. Tension pneumothorax is a clinical diagnosis, so if the patient is unstable, treat first and do not delay decompression for imaging. And don’t get fooled by mimics like skin folds, bullae/emphysema, rotation, or overlying artifact. One of the best checks is simple: if you can clearly trace lung markings beyond the suspected pleural line, reconsider whether it is actually a pneumothorax. Save this for your next internal medicine, emergency medicine, ICU, surgery, or radiology rotation. #Pneumothorax #ChestXray #medicine #medical #medstudent