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Updated: Jun 8, 2026

Point-of-Care Lung Ultrasound in Adults: Image Acquisition
Published on: March 3, 2023
A method to detect occult pneumothorax with chest radiography
Shokei Matsumoto1, Masanobu Kishikawa, Koichi Hayakawa
1Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Yokohama, Kanagawa, Japan. m-shokei@feel.ocn.ne.jp
Occult pneumothoraces are difficult to detect on standard supine chest X-rays, despite accounting for over half of traumatic cases. An oblique view can effectively diagnose these hidden collapsed lungs in trauma patients.
Area of Science:
- Radiology
- Trauma Care
- Pulmonary Medicine
Background:
- Occult pneumothoraces, often anterior, are frequently missed on supine chest radiographs.
- These undetected pneumothoraces constitute a significant proportion (52-63%) of all traumatic pneumothoraces.
Observation:
- A 19-year-old female trauma patient with chest tenderness had unremarkable initial supine radiographs.
- A subsequent right-sided oblique chest radiograph revealed a visceral pleural line, confirming a traumatic pneumothorax.
Findings:
- Supine radiographs have low sensitivity for detecting occult pneumothoraces.
- Specific signs like the "deep sulcus sign" or "double diaphragm sign" may be present but are not always reliable.
Implications:
- Oblique chest radiography is a valuable, rapid screening tool for blunt chest trauma.
- This technique is crucial when CT is not feasible or immediate diagnosis is needed for critically ill or transferred patients.
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