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Loculated pneumothorax with a deep sulcus sign

Corresponding author: David Sotello Contact Information: David.sotello@ttuhsc.edu DOI: 10.12746/swrccc.v6i26.497 A 61-year-old man with amyotrophic lateral sclerosis, s/p tracheostomy, and ventilator dependence was admitted for evaluation of respiratory distress, fever, and increased secretions. Broad spectrum antibiotics were started due to bilateral infiltrates on his admission chest x-ray. One day after admission the patient developed severe left shoulder pain and tachycardia. Chest x-ray showed a pneumothorax with a positive deep sulcus sign in the left hemithorax (Figure 1). A 16 French surgical chest tube was placed with the complication of a persistent air-leak (Figure 2). Eventually, the pneumothorax recurred despite presence of the surgical chest tube, and a second pigtail chest tube was inserted by the Interventional Radiology service (Figure 3).