Imaging in pneumothorax

1. Pneumothorax

2. • Pneumothorax is defined as the presence of
air in the pleural space.

3. Etiology
Pneumothorax
spontaneous
Primary secondary
traumatic
Iatrogenic
Interventional
procedures
Positive
pressure
ventilation
Non Iatrogenic
Penetrating
trauma
Blunt trauma

4. Clinical types
Pneumothorax
Closed open tension

5. Chest radiography
• It is the first intial investigation performed to
asses the pneumothorax.
• As little as 50 ml may be visible on plain
radiograph.
• Diagnosis is mainy based on :
• Visible visceral pleural line
• Absence of vascular markings beyond the
visceral pleural line.

7. Erect position
Small
pneumothorax
Apical lucency
<2cm
Viscreral
pleural line
Large
pnemothorax
Apical lucency
>2cm
Visceral
pleural line
Tension
pneumothorax
Lung collapse
Mediastinal
shift
Low flat
diaphragm

10. Supine position
• Supine radiographs are taken in critically ill , in
ICU patients and in polytrauma conditions.
• 500 ml of air is necessary to detect
pneumothorax in supine patients.

11. • Juxtacardiac area ( anteromedial recess)
,cardiophrenic recess, the lateral chest wall
,the subpulmonic space ,posteromedial
pleural recess and the costophrenic pleural
recess are the best ares to search for
pneumothorax.

12. Anteromedial
• In the supine position, the anteromedial space
becomes the least dependent pleural recess.
As the volume of air increases signs of
pneumothorax will extend into the
subpulmonic space and then into apicolateral
space .

13. • A. Suprahilar Anteromedial Pneumothorax
Sharp delineation of:
• a. Superior vena cava
• b. Azygos vein
• C. Left subclavian artery
• d. AnteriorJunction line
• e. Superior pulmonary vein

14. • B. InfrahilarAnteromedial Pneumothorax
• I . Sharp outline of:
• a. Heart border
• b. Inferior vena cava
• 2. Deep anterior cardiophrenic sulcus
• 3. Outline of medial diaphragm under heart
silhouette
• 4. Unusually sharp delineation of pericardial fat
pad

19. Subpulmonic
• Signs of subpulmonic pneumothorax include:
• Hyperlucent upper quadrant of the abdomen
• Deep lateral costophrenic sulcus
• Visualization of the anterior costophrenic sulcus
and inferior surface of the lung.
• In patients with pneumoperitoneum or subphrenic
abscesses containing air, the upper quadrants can be
hyperlucent and mimic subpulmonic pneumothorax

23. Apicolateral pneumothorax

24. Posteromedial pneumothorax
• Due to the attachments of the lower lobe to
the mediastinum (superiorly at the hilum and
medially by the inferior pulmonary ligament,
which anchors the lobe to the mediaslinum
and diaphragmatic pleura), the appearance of
posteromedial pneumothorax is very
characteristic.

25. • The posteromedial pneumothorax presents as
a lucent triangle with its vertex in the hilum,
and a V-shaped base that delineates the
costovertebral sulcus . The lateral side of the
triangle sharply oullines the flat, displaced
medial surface of the collapsed lobe.

27. Pneumothorax in lobar collapse
• Just as pneumothorax collects
posteromedially in the case of lower lobe
collapse, pneumothorax will outline the
surfaces of the contracted lobe when other
lobes collapse.

28. Periaortic Lucency in Left Upper Lobe
Coliapse

29. Pericaval Lucency in Right Upper Lobe
Coliapse

30. .