Imaging Case of the Week 552 Answer

The chest x-ray shows bilateral skin folds simulating pneumothoraces.

There is linear density along both left and right lung fields with visibility of lung markings beyond the linear densities. This is due to skin fold, which can simulate pneumothorax.

A skin fold results from compression of redundant skin by the x-ray cassette. The skin fold produces an edge whereas a pneumothorax exhibits a pleural line. The edge produced by skin fold rarely continues over the apex.

Skin folds are commonly seen in bedside chest x-rays. If in doubt, chest x-ray should be done with proper patient positioning.

Reference: Fundamentals of Diagnostic Radiology by Brant & Helms.