Question

	This patient presented to the Emergency Department after a head-on MVA. This is a supine chest image taken in the resus room. Is there any evidence of traumatic injury?

Answer

There is a faint white line (white arrows) along the left heart border. This may represent air in the mediastinum (pneumomediastinum) or the medial border of the lung that is no longer in contact with the mediastinum due to pleural air interposition (pneumothorax) There is also evidence of etched diaphragm (black arrow). The medial hemidiaphragm on the left appears too well delineated and there are no lung markings seen in this area. CT Chest There is air in the left pleural space. The faint white line seen on the CXR is the lung edge (white arrow). Also note blood in pleural space (grey arrow) and unusual rib position (black arrow). Also some evidence of pulmonary contusion (not marked)