A MAN was involved in a fight during hospitalization in a state hospital. A chest roentgenogram was obtained, which showed a rib fracture and other features (Fig 1). What are the other features? Answer: emphysema of the chest wall; pneumothorax, left; pneumomediastinum.
The multiple lines of translucency noted in the left hemithorax were caused by air between the muscle fibers in the chest wall and not by pulmonary vascular markings. No vascular marking is recognized in the left hemithorax. Air is observed in the pleural cavity medial to the collapsed lung. A chest film obtained earlier the same day showed the pneumothorax and the collapsed lung.
When soft-tissue emphysema is detected after traumatic injury to a rib, it should be assumed that the lung has been injured, and signs of pneumothorax should be sought. These are (1) demonstration of the lung margin, (2) the absence of lung markings peripheral
Kattan KR. What to Look for in Rib Fractures and How. JAMA. 1980;243(3):262-264. doi:10.1001/jama.1980.03300290044024