A CASE OF TRAUMATIC PNEUMOTHORAX SHOWING ABNORMAL AIR LIKE INTRA-ABDOMINAL FREE AIR

Abstract

We experienced a case of traumatic pneumothorax which was mimicking intraperitoneal free air. The patient injured in a traffic accident underwent on emergency craniectomy due to acute subdural hemorrhage, cerebral contusion, and traumatic subarachnoidal hemorrhage. Chest X-ray examination after the operation showed abnormal air under the right diaphragma and an abdominal CT scan also showed abnormal air anterior the liver surface and lateral to the duodenum. An emergency laparotomy was performed, but, we could not find intraperitoneal free air or gastrointestinal injury. We must notice the risk that CT images for patients with severe shock often show virtual images and easily lead to misunderstanding, because of the restricted time for evaluation of the CT image, difficulty of discussion with other physicians. We can differentiate pneumothorax from intraperitoneal free air by examining whether hepatic round ligament and farciform ligament can be confirmed in the normal position.