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This is the case of a 35-year-old man

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who is complaining of chest pain.

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What I like to do when I encounter chest X-rays, which you'll see lots

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of in the emergency room, is to create a checklist of doing the same

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thing every single time, in every single instance.

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How you do it may differ from

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how I do it, but what I encourage you to do is to find a way and stick to it.

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In that way, you don't forget anything.

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So what I like to do is first to take a look at the lung fields.

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I'm looking for any sorts of nodules.

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Any sorts of plural effusions, airspace consolidation, masses, pneumothoraces.

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I'll take a look at the heart and the mediastinum,

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paying attention to the airway as well.

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We'll look at the bones and the

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soft tissues as we move kind of

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out of the periphery of the examination.

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So in this exam, when I look

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at the left lung field,

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normal lung markings, and everything here looks normal, well expanded.

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There's no focal consolidation, pleural effusion.

1:00

When I come to the right side, and it's a little difficult to see,

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but when you magnify, you can see really nicely, the pleural line that's sitting here.

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Not at the edge of the thorax, but this is a pneumothorax.

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What I like to do with pneumothoraces

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is to give clinicians information that they can use.

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And so what that involves is measuring the air gap.

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And so we'll measure here an apical

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air gap, which is approximately 6cm.

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I'll also provide a lateral air gap,

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which is about 3.4cm. And so, we also want to make sure that with pneumothoraces,

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we're giving clinicians additional information that they can work with.

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And so the big thing we want

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to mention is, is there any evidence of tension?

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And so for tension,

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we're looking for shift of the mediastinum structure, so the airway or the heart

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and mediastinum, away from or in the opposite side of where the pneumothorax is.

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So for a right sided pneumothorax,

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we would expect to see things shifting to the left if there was tension.

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And here we can see that the airway is

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still pretty well aligned with the midline spinal structures.

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We also can look at the distance

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between the ribs and there they look

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pretty symmetric on both sides.

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There is no evidence of tension.

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However, we do have a large right sided pneumothorax.