Teenager in a motor vehicle accident with chest pain

CXR and CT of pneumothorax and pulmonary contusion and rib fracture
CXR AP shows a widened mediastinum and a small right-sided pneumothorax. Axial CT with contrast of the chest with lung (above) and bone (below) windows shows air in the pleural space anterior to the right lung and fluid in the pleural space posterior to the right lung as well as airspace disease in the right lower lobe and a cortical disruption through one of the right ribs posteriorly.

The diagnosis was a right hydropneumothorax, right pulmonary contusion, and right posterior rib fracture. Angiogram was negative for aortic injury.