Tension pneumothorax due to rib fracture

Tension pneumothorax due to rib fracture

This young man fell off his bike and landed on his left side. His CXR shows a large left pneumothorax (pleural line indicated by white arrows) with shift of the trachea and mediastinum to the right. There is a subtle fracture of one of the lower left ribs (yellow arrow). Note also the extensive surgical emphysema extending into the neck (orange arrows).