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© 2002
Recognizing
A Pneumothorax
When air enters the pleural space, the parietal and visceral
pleura separate making the visceral pleura visible
The thin white line of the visceral pleura is called the
visceral pleural white line
You must see the visceral pleural white line to make
diagnosis of pneumothorax!
A pneumothorax will be
visible as a thin white
line - the visceral pleural
white line
Lung Markings
white line
But they can be seen distal to the visceral pleural white line
even with a pneumothorax if lung is folded on itself
Absence of lung markings is not sufficient to make diagnosis
of pneumothorax!
Why The Pleural White Line
Is Important
ARRS R3 ©
ARRS R3 ©
weight
This skin fold can mimic a pneumothorax
Skin Fold Pneumothorax
Dense
Lucent
Skin Fold
Lucent
Dense
Lucent
Pneumothorax
This is an
edge =
skin fold
Which is this?
Skin fold or Pneumothorax
This is a line =
pneumothorax
Types of Pneumothoraces
Visceral
pleural white
line
Air enters Right hemithorax either from tear in lung or hole in chest
wall on inspiration; does not exit on expiration
Shift of heart and
trachea to left
Complete right-sided
pneumothorax
Lung is compressed
against mediastinum
Which is this?
Simple or Tension Pneumothorax
Spontaneous
Rupture of an apical sub-pleural bleb usually in a tall,
thin male
Trauma
Through chest wall, e.g. stab wound
Internal, e.g. rupture of a bronchus from a motor vehicle
collision
Causes of a Pneumothorax
This is a skin
fold. It is an
edge, not a
line.
ARRS R3 ©
Pneumothorax
There is a left-sided
tension
pneumothorax with
shift of the heart
and mediastinal
structures to the
right.