The image above shows a large left sided effusion, likely hemothorax as there is a rib fracture noted on the same side (red arrow). With the history of alcohol abuse, likely the patient experienced a fall while inebriated, resulting in rib injury and hemothorax. Patients who have had a previous volume reduction of lung (i.e. lobectomy) may have a similar appearance with white out of the lung, and this may be seen in other situations of lung volume loss. They key to telling the difference: Look at the trachea (purple arrow). An effusion will cause deviation away from the white lung, while volume loss causes deviation toward the white side. This patient's trachea is deviated to the right. A bedside echo showed no pericardial effusion, however there was tamponade type cardiac activity likely secondary to tension hemothorax. The solution to hypotension is to supply preload and relieve the effusion with a chest tube (while considering other trauma and evaluating for that, of course!).
A 72 year old man presents with complaints of lower back pain. He states that he was cleaning out his garage earlier this week and noted he developed a sudden episode of lumbar back pain that radiated to the right side. The pain subsided after a few minutes. He had no other associated symptoms, and his vital signs are normal. He has since been having intermittent lumbar/R lower back pain. A lumbar spine series was obtained in triage, and you note the image below. What is the main abnormality noted? What further imaging should you obtain? If the patient were to become suddenly hypotensive, what would you management priorities be?