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A 28-year-old Man with Air in the Mediastinal Space after  a Car Accident (Anesthesiology, Oct 2012) A 28-YR-OLD man was admitted to a level I trauma center because of blunt high-energy chest trauma. The chest radiograph ray showed a radiolucent line left of the heart, suggestive of pneumomediastinum (fig. A: radiograph on admission; fig. B: magnification of the white rectangle in fig. A; white arrows mark the radiolucent line. In figs. A and B, an electrocardiogram cable is visible). Chest and pericardial drains were inserted, after which hemodynamic function improved. Bronchoscopy revealed a 2-cm full-thickness longitudinal airway tear. The lesion began at the carina and continued into the right main bronchus (RB) (fig. C: a bronchoscopic picture of the right main bronchus; the outlined area shows the bronchial lesion [LB left bronchus]). Tracheobronchial injuries are life threatening and often are no...

Know the sulcus sign  and make the pneumothorax Diagnosis... Pneumothorax is frequently difficult to diagnose in the operating room or PACU . Sometimes it   is   obvious, with a hypoxic patient and absent breath sounds. But not usually. Most of the time we rely on a chest xray to help make the diagnosis. Unfortunately, the good old   chest xray only shows a pneumothorax about 30-50% of the time . A big part of the problem is that our patients are usually supine.A small pneumothorax make float anteriorly in the supine position, and if it is not big enough to wrap around the lateral edge of the lung, it may remain invisible. So you need to look for gross   and   subtle signs on the image that will help make the diagnosis. The deep sulcus sign is one of the more subtle signs.  Simply stated, the deep sulcus sign is a radiolucent (dark) lateral sulcus where the chest wall meets the diaphragm. The amount of lung in this...