Bilateral traumatic pneumothoraces with bilateral deep sulcus signs

Abstract

Fig. 1. Supine chest radiography shows bilateral deep sulcus signs (arrows) and multiple rib fractures (arrowheads). A 33-year-old man was brought to our emergency department by ambulance after a traffic accident. On arrival, he was drowsy, and dyspnea was noted. He had a respiratory rate of 26 breaths/ min, an oxygen saturation of 88% on a rebreather face mask, a blood pressure of 80/58 mmHg, and a pulse rate of 114 beats/min. The breath sounds over the anterior left side of his chest were decreased, and multiple abrasions were noted over the anterior chest wall. Needle decompression was performed immediately under the impression of tension pneumothorax. A supine chest radiograph revealed both lateral costophrenic angles were abnormally deepened with increased lucency (Fig. 1, arrows) and left rib fractures (Fig. 1, arrowheads). A chest tube was placed on the left side, and the chest computed tomography revealed bilateral pneumothoraces with lung collapse (Fig. 2). A chest tube was placed on the right side, and a repeat chest radiograph revealed decreases in both deepened and hyperlucent lateral costophrenic angles (Fig. 3). After resuscitation, he was transferred to the intensive care unit and discharged home in stable condition 1 month later. Traumatic pneumothorax is an emergency, and is sometimes difficult to identify in critically ill patients. The majority of cases can be diagnosed on an upright posteroanterior chest radiograph [1]. However, only supine chest radiographs are possible in some patients, such as those who have undergone major trauma or are in the intensive care unit. Approximately 30% of pneumothoraces are undetected on supine radiographs because the visceral pleural