Newborn after repair of a left-sided congenital diaphragmatic hernia

CXR after congenital diaphragmatic hernia repair showing no need for a chest tube
CXR AP (above) taken immediately postop shows that the hypoplastic left lung cannot expand to completely fill the pleural space particularly in the basilar region and subsequently there is a moderate amount of air in the pleural space. This should not be called a pneumothorax. CXR AP taken 1 day later (below) shows the left pleural space now filling with fluid.

The diagnosis was normal post-operative appearance after congenital diaphragmatic hernia repair.

Young adult with cystic fibrosis with continued shortness of breath after chest tube placement

CXR of chest tube malposition with chest tube in the lung parenchyma
CXR AP (left) shows chronic interstitial fibrosis and scarring in the lungs, a left-sided chest tube, and a moderately-sized basilar left pleural air collection manifesting as a deep sulcus sign. Gross pathological specimen (right) shows the left chest tube entering the upper lobe of the left lung.

The diagnosis was persistent pneumothorax in a patient with cystic fibrosis due to the chest tube tip not being in the pleural space.

Teenager in motor vehicle accident with continued shortness of breath after chest tube placement

CT of chest tube malposition with chest tube in the lung parenchyma
Axial and coronal and sagittal CT with contrast of the chest shows a large amount of air in the left pleural space. The left chest tube is clearly located within the air space disease in the posterior left lung parenchyma in all three planes.

The diagnosis was persistent pneumothorax in a thoracic trauma patient with pulmonary contusion due to the chest tube tip not being in the pleural space.

Premature newborn after chest tube placement

CXR of chest tube malfunction with chest tube in the subcutaneous tissues of the chest wall
CXR AP shows diffuse ground glass opacity throughout the lungs and a large amount of air in the right pleural space causing mediastinal shift to the left while the right-sided chest tube courses through the subcutaneous tissues of the right chest wall and never enters the right pleural space.

The diagnosis was persistent pneumothorax in a patient with respiratory distress syndrome due to the chest tube tip not being in the pleural space.

Teenager with abnormal pleural-based nodules on CXR who had sustained blunt abdominal trauma in the remote past

CXR and CT and Tc-99m sulfur colloid scan of diaphragmatic rupture
CXR AP shows a left-sided large pleural nodule just beneath the clavicle. Axial CT with contrast of the chest shows multiple pleural nodules throughout the left hemithorax and absence of the spleen. Tc-99m sulfur-colloid scan shows normal radiotracer uptake in the liver with no uptake in the region of the spleen (lower left), and nodular uptake throughout the left hemithorax (lower middle) and abdomen (lower right).

The diagnosis was diaphragmatic rupture and post-traumatic splenosis.

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.

Teenager playing football struck in chest with chest pain

CT of sternoclavicular joint dislocation
CXR AP shows a widened superior mediastinum. Axial CT with contrast of the chest shows a mediastinal hematoma and a right sternoclavicular joint disruption that was displaced posteriorly. Angiogram was negative for aortic injury. Venogram was negative for large vessel venous injury.

The diagnosis was sternoclavicular joint dislocation with the mediastinal hemorrhage thought to be due to small vessel venous injury.