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Minimal pneumothorax chest postero anterior view vs opposite lateral decubitus view.


A pneumothorax is defined as air in pleural space, that is air between lung and the chest wall. Pneumothorax can be divided into spontaneous pneumothorax, which further divided into primary and secondary traumatic pneumothorax, which further divided into Iatrogenic and Non-Iatrogenic (Artificial). Common clinical manifestations include unilalteral chest pain and dyspnoea.


Patients with age between 20 and 60 years with secondary spontaneous pneumothorax were included in the study.

Patient with Tuberculosis, old or new were excluded from the study.

Chest x-ray PA view, chest x-ray opposite lateral decubitus view, computerised tomography. Fifty patients of minimal pneumothorax were selected for the study. Chest PA view and opposite lateral decubitus view was done for all the patients and a comparitive study was done.


In 30 patients both PA and opposite lateral decubitus views showed pneumothorax. In 15 patients PA view even expiratory film was unable to diagnose pneumothorax, but opposite lateral decubitus view showed pneumothorax with collapsed lung border and deep sulcus sign. In 5 patients, both PA and opposite lateral decubitus views were not able to diagnose pneumothorax and finally diagnosed with CT scan.





The most common mode of presentation is sharp unilateral chest pain. This is frequently accompanied by shortness of breath, although pain may be the sole presenting symptom in two-third of patients. (1) The majority of cases of spontaneous pneumothorax are unassociated with physical exertion. (2,3,4)

If a pneumothorax is suspected clinically, but not detected on a standard inspiratory film, then two procedures may be used to conform the diagnosis. In the first chest radiograph is taken on expiration, this has the effect of reducing the volume of both the thorax and the partially deaerated lung.

As the volume of air within the pleural cavity is incompressible at physiological pressures, it remains the same on expiration and pneumothorax, therefore appears to enlarge in relation to the smaller thoracic volume.

In the second method, the chest radiograph is taken in lateral decubitus position with the side on which the pneumothorax is suspected uppermost. (5)

Even a small pneumothorax is revealed by this technique as the air lung interface is clearly visible beneath the lateral chest wall. This is also preferred view for demonstrating pneumothorax in infants. Also helpful for determining effusion is free flowing and whether there is enough fluid to sample with thoracocentesis.


In minimal pneumothorax, opposite lateral decubitus view is the preferred investigation over PA view expiratory film. It is not only helpful in the diagnosis, but also prevents further expensive investigations like CT scan and helpful in residency period where we usually miss very minimal pneumothorax.


(1.) Lidskog GE, Halasz NA. Spontaneous pneumothorax: a consideration of pathogenesis and management with review of 72 hospitalized cases. AMA Arch Surg 1957;75:693.

(2.) Hallgrimsson JG. Spontaneous pneumothorax in Iceland with special reference to the idiopathic type: a clinical and epidemiological investigation Scand J Thorac Cardiovasc Surg 1978; Suppl 21:3.

(3.) O'Hara VS. Spontaneous pneumothorax. Milit Med 1978;143:32.

(4.) Bense L, W iman LG, Hedenstierna G. Onset of symptoms in spontaneous pneumothorax: correlations to physical activity. Eur J Respir Dis 1987;71:181.

(5.) Felson B. Chest Roentgenology. Philadelphia: WB Saunders, 1973:392.

Krishna Chaitanya Panyam [1], Pradyut Waghray [2], Venkateswara Reddy Tummuru [3], Hasnani Rikin Bahadurbhai [4]

[1] 2nd Year, Post Graduate, Department of Pulmonary Medicine, SVS Medical College and Hospital.

[2] Professor and HOD, Department of Pulmonary Medicine, SVS Medical College and Hospital.

[3] Assistant Professor, Department of Pulmonary Medicine, SVS Medical College and Hospital.

[4] 2nd Year Post Graduate, Department of Pulmonary Medicine, SVS Medical College and Hospital.

Financial or Other, Competing Interest: None.

Submission 04-12-2015, Peer Review 05-12-2015, Acceptance 23-12-2015, Published 28-12-2015.

Corresponding Author:

Dr. Krishna Chaitanya Panyam, H. NO. 11-13-617, Haripuri Colony, Road No. 2, SRK Puram, Hyderabad-500035.


DOI: 10.14260/jemds/2015/2561
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Title Annotation:Case Report
Author:Panyam, Krishna Chaitanya; Waghray, Pradyut; Tummuru, Venkateswara Reddy; Bahadurbhai, Hasnani Rikin
Publication:Journal of Evolution of Medical and Dental Sciences
Date:Dec 28, 2015
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