Incidental detection of extrapleural air in a paediatric trauma patient: a diagnostic challenge

The intrathoracic extrapleural space is an anatomical region seldom encountered in routine clinical practice, with pathological processes in this location being infrequent. The incidental detection of free air within this space presents a considerable diagnostic challenge due to the difficulty in determining its precise aetiology. We report the case of a young male involved in a road traffic collision who underwent CT of the brain, cervical spine, abdomen and pelvis. Notably, CT unexpectedly demonstrated the presence of air within the right intrathoracic extrapleural space.This case highlights the diagnostic issues associated with such an unusual finding, with an uncommon aetiology of barotrauma. Furthermore, it reiterates the critical role of in-depth radiological assessment in trauma patients, ensuring that rarely encountered imaging findings are accurately identified and appropriately interpreted to guide appropriate clinical management.