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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
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.
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.
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