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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Rupture of air at the root of the lung or from rupture of subpleural blebs due to 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.
In a patient who is supine with a pneumothorax, the air in the pleural space collects in the anterior and medial portions of the pleural space, according to the laws of gravity. In this case, the classical signs of a pleural line in an apical or lateral position will not be seen. Instead, indirect signs of a pneumothorax such as increased lucency in the lung base and an inverted hemidiaphragm or "deep sulcus sign" will be seen. Any time there is suspicion of a pneumothorax on a supine film one should immediately attempt to confirm it with a horizontal beam film - either a cross table lateral or preferably a lateral decubitus film.
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