A chest x-ray may be helpful in the diagnosis of pneumothorax. Findings on an x-ray suggestive of pneumothorax include absent lung markings, white pleural lines, mediastinal shift to the opposite side, atelectasis, air fluid levels in pleural space, and deep sulcus sign. X-ray challenges for pneumothorax include air trapped between chest wall and arm will be seen as a lucency rather than a visceral pleural white line, scapula edge should be followed to make sure it does not project over chest, skin fold appear thicker than the thin visceral pleural white line, and emphysematous bullae can be seen as convexity laterally.

• An x-ray may be helpful in the diagnosis of pneumothorax. Findings on an x-ray suggestive of pneumothorax include:^[1]
  • Absent lung markings
  • White pleural lines
  • Mediastinum shift to the opposite side
  • Atelectasis
  • Air fluid level in pleural space
  • Outline of diaphragm under the heart
  • Deep sulcus sign
  • Increased rib separation
  • Ipsilateral flattening of heart border
  • Midiaphragmatic depression

• Skin fold appear thicker than the thin visceral pleural white line
• Air trapped between chest wall and arm will be seen as a lucency rather than a visceral pleural white line
• Follow scapula edge to make sure it does not project over chest
• Emphysematous bullae seen as convexity laterally