Академический Документы
Профессиональный Документы
Культура Документы
Signs in Imaging
Andrew Kong, MD
EXPLANATION
When the patient is in the supine position, air in the pleural
space (pneumothorax) collects anteriorly and basally within
the nondependent portions of the pleural space; when the
patient is upright, the air collects in the apicolateral location.
If air collects laterally rather than medially, it abnormally
deepens the lateral costophrenic angle and produces the deep
sulcus sign.
DISCUSSION
Air enters the pleural space by crossing any of its boundaries,
such as the chest wall, mediastinum, lung, or diaphragm (2).
Recognition of a pneumothorax depends on the volume of air
in the pleural space and the position of the body. The deep
sulcus sign is a useful clue in the diagnosis of pneumothorax in
neonates or in critically ill patients such as those who have
undergone major trauma or are in intensive care units (2,3).
These patients are least capable of communicating that they
are experiencing dyspnea and pleuritic chest pain, which are
the typical symptoms of pneumothorax.
The visceral pleural line, which is visible as a thin curvilinear
opacity along the lung and is separated from the chest wall by
air in the apical pleural space in the upright patient, is com-
Index terms:
Pneumothorax, 66.73
Signs in Imaging
Published online
10.1148/radiol.2282020524
Radiology 2003; 228:415 416
monly not identifiable on radiographs of supine patients unless there is a sizable pneumothorax. Approximately 30% of
pneumothoraces are undetected on supine radiographs (3).
The deep sulcus sign of pneumothorax may be present following severe chest injury (4). It is important that the lateral
costophrenic angles are included on the radiograph, as failure
to diagnose pneumothorax may be life-threatening because of
the risk of tension. This is also important in the intensive care
setting for procedures such as insertion of a subclavian central
venous catheter and for the use of positive pressure ventilation.
In addition to the deep sulcus sign, other clues may suggest
the presence of a pneumothorax on supine radiographs (2,5,6):
(a) relative lucency in the hypochondrial region or the entire
RSNA, 2003
415
Radiology
416
Radiology
August 2003
Kong