Radiologic Features of Extrapleural Emphysema in Thoracic Injuries and Trauma

Background: This article explores the anatomical structure of the chest wall, with a particular focus on the extrapleural space, its radiologic visualization, and its role in the development of certain pathological processes following thoracic injuries and trauma. Among the pathological mechanisms involved in severe combined injuries that lead to life-threatening complications, the entry of air into internal body cavities is particularly significant. One such complication is tension pneumothorax. According to the clinical guidelines issued by the Main Military Medical Directorate, pleural drainage is recommended as a therapeutic measure at the stage of qualified or specialized medical care upon diagnosis of pneumothorax, regardless of its type.

AIM: To assess the diagnostic capabilities of imaging modalities for identifying extrapleural emphysema in chest injuries and trauma.

MATERIALS AND METHODS: The primary imaging techniques for diagnosing pneumothorax are chest radiography and ultrasound. According to both domestic and international literature, these methods demonstrate high specificity, approaching 100%.

RESULTS: In our study, systematic use of computed tomography revealed distinctive radiologic signs of air in the extrapleural space in the absence of parietal pleura damage. On radiographs, these conditions appear as a radiolucent stripe along the inner surface of the chest wall. On ultrasound, they are visualized as a “sandy beach” sign with absent visceral pleural sliding, which is often mistakenly interpreted as pneumothorax. In such cases, attempts to drain the pleural cavity increase the likelihood of chest tube misplacement into the extrapleural space due to disrupted anatomical relationships within the chest wall layers. In cases of inadequate medical management during patient transport, subcutaneous emphysema tends to progress.

CONCLUSION: Thus, identifying air in the extrapleural space helps avoid unnecessary invasive procedures and additional iatrogenic injuries. Our study identified key radiographic features that distinguish extrapleural emphysema from pneumothorax: predominant localization in the basal regions, well-defined borders, and the presence of concurrent subcutaneous emphysema and pneumomediastinum.