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A 28-year-old man presented with an open stab wound to the left lower posterior chest wall. The patient's airway was not compromised. Initially, the patient was tachycardic and hypoxic but normotensive. Following initial resuscitation and application of an occlusive dressing to the open wound, an immediate supine chest radiograph demonstrated pronounced subcutaneous emphysema that consequently made interpretation of the image difficult (figure 1). At the time, failure to appreciate the slightly deepened left costophrenic angle and increased lucency compared to the contralateral side (deep sulcus sign) prevented consideration of an anterior pneumothorax and chest drain …
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.