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Pneumothorax in supine projection

A pneumothorax does not display classical signs when a patient is positioned supine for a chest radiograph. Instead, the pneumothorax may be demonstrated by looking for the following signs:

  • relative lucency of the involved hemithorax
  • deep, sometimes tongue-like, costophrenic sulcus: deep sulcus sign 2
  • increased sharpness of the adjacent mediastinal margin and diaphragm
  • increased sharpness of the cardiac borders or diaphragm
  • visualization of the anterior costophrenic sulcus: double diaphragm sign 3
  • visualization of the inferior edge of the collapsed lung above the diaphragm
  • depression of the ipsilateral hemidiaphragm
  • lumpy appearance of the cardiac contour representing change in shape of the pericardial fat: pericardial fat tag sign
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Article information

rID: 4994
System: Chest, Trauma
Section: Signs, Gamuts
Tag: stub, stub
Synonyms or Alternate Spellings:
  • Pneumothorax in supine patient
  • Supine pneumothorax

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Cases and figures

  • Figure 1: pneumothorax in supine position
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  • Case 1
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  • Case 2
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  • Deep sulcus sign
    Case 3: with deep sulcus sign
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  • Case 4: sharp right hemidiaphragm
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  • Case 5
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  • Case 6
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  • Case 7: pericardial fat tag sign
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  • Case 8: bilateral pericardial fat tag signs
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  • Case 9: sharp right hemidiaphragm
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  • Case 10: right apical PTX and skin fold
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  • Case 11: right PTX, sharp diaphragm and retrodiaphragmatic pericardial fat tag sign
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  • Case 12: subtle bilateral PTX with paravertebral hematomata
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