Chest radiograph interpretation: No obvious pneumothorax, hemothorax, focal pulmonary contusion, or mediastinal shift is visible on this single frontal chest radiograph. Lung markings extend to both chest walls and apices, and the costophrenic angles are sharp.

Impression: No acute cardiopulmonary abnormality on this film. In this trauma setting, a small or occult pneumothorax cannot be excluded by a normal chest X-ray.

If she is unstable or has unilateral reduced breath sounds, hypotension, distended neck veins, or worsening respiratory distress, treat suspected tension pneumothorax immediately, without waiting for imaging. In a stable patient with persisting symptoms, perform eFAST/lung ultrasound and consider CT chest. Small traumatic pneumothoraces may be missed on the initial radiograph. Fishman's Pulmonary Diseases and Disorders, p. 1413-1414.

Impression: Essentially normal chest X-ray, with no obvious acute traumatic intrathoracic injury.

A normal AP trauma radiograph does not exclude a small or occult pneumothorax. If clinical suspicion remains high, do eFAST/lung ultrasound or CT chest in a stable patient. The ACS trauma imaging guidance considers ultrasound an adjunct to chest radiography for detecting traumatic pneumothorax/hemothorax.