Radiology Round 1 Posted by webmaster
on June 20 2007
Mr. T, 58 years old, was riding his motorbike which was hit by a truck from behind. He lost his balance and fell on the road. About 45 minutes later, he was brought to the emergency department by on-lookers from the accident site.
Physical evaluation revealed a well built gentleman complaining of chest pain. There was no history of loss of consciousness or vomiting. His pulse rate was 120/min, respiratory rate was 28/min, the pulse oximetry monitor showed 94% on 8 litres of oxygen by mask.
A portable X-ray of this chest which was taken in the emergency department is shown below:
What is your interpretation of this radiogram?
(Scroll down for the discussion after thinking!)
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Haemothorax is a collection of blood in the pleural space.
Although there is no radiological evidence of rib-fractures in this patient, this is the result of lung parenchymal and minor venous injuries. Most small-moderate haemothoraces are not detectable by physical examination (decreased chest expansion, dullness to percussion and reduced breath sounds) and will be identified only on Chest X-ray and other imaging modalities.
It is important to remember that it takes approximately 400-500ml of blood to obliterate the costo-phrenic angle on an ERECT chest radiograph. Since most trauma patients undergo X-rays in the supine position, no fluid level is visible as the blood lies posteriorly along the posterior chest. However, the chest X-ray would demonstrate diffuse non-segmental opacification, through which lung markings can be visualised, as noted on this X-ray.
