Fletcher B D
AJR Am J Roentgenol. 1978 Mar;130(3):469-72. doi: 10.2214/ajr.130.3.469.
In a series of 235 consecutive infants with respiratory distress syndrome, pneumothorax was demonstrated radiographically in 20. On anteroposterior supine chest radiographs of such infants, the intrapleural gas tends to seek an anteromedial position within the involved hemithorax. When the pneumothorax is large, the gas may cause the ipsilateral mediastinal pleura to bulge and herniate across the anterior mediastinum into the contralateral hemithorax. This was seen in 12 or the 14 right pneumothoraces, but only in two of the 10 left ones. The gas-containing sac appeared radiologically as a crescent-shaped lucency medial to the upper thoracic spine which was sharply delineated laterally by the mediastinal pleural layers and the somewhat atelectatic contralateral lung. In some patients treated with a chest tube, the gas disappeared more slowly from the herniated portion of the pleural sac than from elsewhere in the pleural space. Therefore, in addition to being a useful confirmatory sign of pneumothorax, this finding is also important in assessing the completeness of pleural drainage.
在连续的235例呼吸窘迫综合征婴儿中，经X线检查证实有20例发生气胸。在此类婴儿的前后位仰卧位胸部X线片上，胸腔内气体倾向于在患侧胸腔内寻找前内侧位置。当气胸较大时，气体可导致同侧纵隔胸膜膨出并穿过前纵隔疝入对侧胸腔。在14例右侧气胸中，有12例出现这种情况，但在10例左侧气胸中只有2例出现。含气囊在X线片上表现为上胸椎内侧的新月形透亮区，其外侧由纵隔胸膜层和部分肺不张的对侧肺清晰界定。在一些接受胸腔闭式引流治疗的患者中，胸腔内气体从胸膜囊疝出部分消失的速度比从胸膜腔其他部位消失的速度更慢。因此，除了作为气胸的有用确诊征象外，这一发现对于评估胸腔引流的彻底性也很重要。
