SUMMARYPneumothoraces in supine patients may be evidenced by many signs – some specific, if uncommon. Occasionally, the normal distribution of intrapleural air is altered. Confirmatory views may be necessary and the supine oblique is an underused but useful film.ABSTRACTThe radiological signs of a supine pneumothorax, the factors modifying these signs and useful confirmatory views are presented. Common signs include lower zone lucency, a deep lateral sulcus, a visible anterior costophrenic sulcus and paramediastinal or paradiaphrag‐matic air. Specific but uncommon signs are interlobar air and a change in appearance of epicardial fat pads. The signs may be modified – especially by pleural adhesions. An oblique beam view with the patient supine may be very useful to confirm a pneumothorax.
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