Pneumothorax detection in patients with apical pleural caps

Area of Science:

• Radiology
• Pulmonary Medicine
• Thoracic Imaging

Background:

• Small apical pneumothorax is typically identified by a thin line on chest radiographs, representing the retracted visceral pleura.
• The apical visceral pleura can occasionally thicken, forming an 'apical cap'.
• This apical cap can alter the radiographic appearance of apical pneumothorax.

Purpose of the Study:

• To describe a previously unreported variant presentation of apical pneumothorax caused by a thickened apical cap.
• To enhance the detection of apical pneumothorax by recognizing this variant radiographic finding.

Main Methods:

• Review of chest radiographs demonstrating apical pneumothorax.
• Identification and characterization of cases with a thickened apical cap.
• Comparison with typical presentations of apical pneumothorax.

Main Results:

• A variant presentation of apical pneumothorax associated with a thickened apical cap was observed.
• This finding differs from the classic 'pencil-thin white line' appearance.
• The thickened apical cap may obscure or mimic other findings.

Conclusions:

• The presence of a thickened apical cap represents a variant presentation of apical pneumothorax.
• Awareness of this variant is crucial for accurate diagnosis and improved detection of apical pneumothorax.
• This description adds to the understanding of radiographic findings in small pneumothoraces.