HSS What's the Diagnosis Case #117

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What’s the Diagnosis – Case 117

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Findings The radiographs demonstrate a comminuted fracture of the middle third of the left clavicle. CT study confirms the fracture but also demonstrates a subtle fracture of the acromion and multiple rib fractures. A moderate to large left sided pneumothorax (ptx) is present seen on the lung window. On review, the radiographs demonstrate an absence of lung markings of the left lung apex and a pleural line.

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Diagnosis: Post traumatic Pneumothorax As compared to many of the cases we have shown this case is much more of an “eye test”. The findings particularly on the radiographs although difficult can be made and are imperative. More frequently present in the setting of rib fractures with a clavicle fracture as in this case, isolated clavicle fractures can also rarely present with a pneumothorax. Given the size of the pneumothorax this patient underwent chest tube decompression with re-expansion of the lung and then subsequent clavicle fracture fixation.

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References Pneumothorax complicating isolated clavicle fracture. Redouane Hani, Badr Ennaciri, Idriss Jeddi, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada1. Pan Afr Med J. 2015; 21: 202. Published online 2015 Jul 20. doi: 10.11604/pamj.2015.21.202.6796

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