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Rib Fractures
Assuming that clinical information does not suggest that a major injury is likely, a chest xray is taken to rule out a pneumothorax or another major complication such as aortic tear.
A pneumothorax is the presence of air in the pleural cavity. Air enters this cavity through a defect in either the parietal or the visceral pleura. If air can move freely in and out of the pleural space during respiration it is an open pneumothorax, if no movement of air occurs it is closed and if air enters the pleural space on inspiration, but does not leave on expiration, it is valvular. As intrapleural pressure increases in a valvular pneumothorax a tension pneumothorax develops.
Radiographic Appearances:
A small pneumothorax in a free pleural space in an erect patient collects at the apex. The lung apex retracts towards the hilum and on a frontal chest film the sharp white line of the visceral pleura will be visible, sperated from the chest wall by the radiolucent pleural space, which is devoid of lung markings. The affected lung usually remains aerated: however perfusion is reduced in proportion to ventilation and therefore the radiodensity of the partially collapsed lung remains normal.
The Tension Pneumothorax may lead to massive displacement of the mediastinum, kinking of the great veins and acuate cardiac and respiratory embarassment. Radiologically the ipsilateral lung may be squashed against the mediastinum, or herniate across the midline, and the ipsilateral hemidiaphragm may be depressed.
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