Adult Critical Care Specialty (ACCS) Practice Exam

What does the deep sulcus sign on a chest radiograph typically indicate?

1. Pneumothorax

2. Pleural effusion

3. Pneumonia

4. Chronic obstructive pulmonary disease

The correct answer is: Pneumothorax

The deep sulcus sign on a chest radiograph typically indicates a pneumothorax. This sign refers to the appearance of a deepened costophrenic angle on an upright lateral chest film, which is a result of the accumulation of air in the pleural space. When air enters the pleural cavity, it causes the lung to collapse and the mediastinum to shift, creating a more pronounced space or "sulcus" at the base of the lung. This can be a crucial sign in identifying pneumothorax, especially in a patient who may present with sudden chest pain and shortness of breath. In contrast, other conditions such as pleural effusion would typically show blunting of the costophrenic angles due to fluid accumulation, rather than the deepening seen with pneumothorax. Pneumonia may present with other radiographic signs such as infiltrates or consolidations, while chronic obstructive pulmonary disease is characterized by hyperinflated lungs and other features not associated with the deep sulcus sign. Thus, recognizing the deep sulcus sign can be vital in the timely diagnosis and management of a pneumothorax.