Imaging description

Various artifacts can be mistaken for pneumothoraces. These include skin folds, giant bullous emphysema, calcified pleural plaque, folds of blankets or clothing, lateral edges of breast tissue, and the medial border of the scapula [1–4].

Skin folds mimicking pneumothoraces can be distinguished from true pneumothoraces by looking for lung markings beyond the skin fold and discriminating between the abrupt interface or edge caused by skin folds and the thin white visceral pleural line of a pneumothorax (Figure 32.1). In addition, interfaces or edges related to skin folds may extend beyond the thoracic cavity.

Giant bullous emphysema mimicking tension pneumothorax can be distinguished from true tension pneumothorax by the lack of hemodynamic instability in giant bullous emphysema, lack of re-expansion after thoracostomy tube placement, and septations and vessels within bullous emphysema on CT (Figure 32.2).

Calcified pleural plaques seen tangentially can mimic the visceral pleural line of a pneumothorax. This pitfall can be recognized by identifying a white line that is thicker than that typical for the visceral pleural line of a pneumothorax. In addition, the white line created by a calcified pleural plaque will not follow the expected contour of the lung. The presence of other calcified pleural plaques is another clue that this pitfall may be present.