Identification of tension hemopneumothorax on supine chest radiograph: Value of the visceral pleural line sign

Abstract

Tension hemopneumothorax is a life-threatening condition produced by either blunt or penetrating chest or thoracoabdominal trauma. The purpose of this study is to describe and illustrate the signs of tension hemopneumothorax on the supine chest radiograph. Review of the initial supine chest radiograph of 11 patients who were thought to have tension hemopneumothorax secondary to major blunt chest trauma constitutes the method of the study. The results of the study indicate that signs of tension hemopneumothorax include the visceral pleural line sign and shift of the mediastinal structures to the opposite side with or without a deep sulcus sign. These observations on the supine chest radiograph were confirmed by erect chest radiography in one patient, axial computed tomography in two patients, and clinically at the time of tube thoracostomy and by postthoracostomy intubation supine chest radiographs in eight patients. We conclude, therefore, that tension hemopneumothorax is recognizable on supine chest radiographs by the visceral pleural line sign and contralateral mediastinal shift with or without a deep sulcus sign, that tension hemopneumothorax is distinguishable from hemopneumothorax, hemothorax, and extrapleural hematoma, and that the radiologic distinction is clinically significant.