This patient was referred for chest radiography post transbronchial lung biopsy on the right. The lungs are abnormal demonstrating mixed alveolar/interstitial opacity. There is an impression of a right apical pneumothorax. There is also a suggestion of a small subpulmonic pneumothorax on the right.
	The lateral chest suggests a small subpulmonic pneumothorax on the right (arrowed)
	An enlargement of the lung apices demonstrates a right sided pneumothorax with the visceral pleural surface oof the right lung projected over the third rib. Note that there are no lung markings on the right between the second and third rib posteriorly- compare with the left side. It is noteworthy that a pneumothorax will occasionally show improved demonstration on the inspiration rather than the expiration view if expiration moves the lung edge of a rib into a rib interspace.

This 36 year old male presented to the Emergency Department with spontaneous onset of central chest pain and discomfort. This is an erect chest image performed on inspiration. There is complete collapse of the left lung.

An expiration PA erect chest was also performed. This case provides support for performing the PA inspiration view first before proceeding to the expiration view. The converse could also be argued- perform the expiration view first for detection of pneumothorax, then proceed to the inspiration view if required for sizing of the pneumothorax. Comment 1 This case demonstrates the fact that lungs are mostly air- in cases of severe pneumothorax such as this, the lung parenchyma can be seen to collapse to a relatively small volume. Comment 2 A colleague has suggested to me that tension pneumothorax is a difficult diagnosis on plain film. When the lung collapses the most compliant contiguous structures will displace the most- this could be diaphragm or mediastinum or both. This image suggests a degree of tension but, when compared with the inspiration view, the appearance is largely attributable to the phase of respiration.