CT chest demonstrating a large left pneumothorax
What if you have an equivocal bedside ultrasound result in looking for a pneumothorax, and the patient is too unstable to go to CT?
Trick of the Trade:Oblique CXR
Matsumoto et al in Annals of EM just reported this great tip. Position a film plate oblique to the patient's chest as shown in the above diagram from the article. "OPX" designates an Occult PneumothoraX. The x-ray beam is now more tangential to the edge of the anterior pneumothorax. This allow us to detect free air more easily.
Supine CXR, oblique view
Matsumoto S, Kishikawa M, Hayakawa K, Narumi A, Matsunami K, Kitano M. A method to detect occult pneumothorax with chest radiography. Ann Emerg Med. 2011, 57(4), 378-81. PMID: 20864214