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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Etiology/Pathophysiology:
Caused by rupture of air at the root of the lung or from rupture of
subpleural blebs due to increased over inflation of the lung from the
ventilator. Air in the pleural space can lead to acute compromise of
pulmonary ventilation and vascular perfusion (air block) which can
lead rapidly to respiratory distress and vascular collapse.
Pathology:
Not applicable.
Imaging Findings:
Air in the pleural space is demonstrated classically on a horizontal
beam film (upright, cross table lateral or decubitus film) that shows
air accumulating in the pleural space along the apical or lateral
margins of the hemithorax. A pleural line is seen which shows the
interface between the air in the pleural space and the collapsed
lung. 
Another related sign is the lack of lung markings
extending out to the chest wall. Pneumothoraces are difficult to spot
in a patient on a supine film.
DDX:
Not applicable.
References:
See References Chapter.
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