Humeral fractures on CXR

When you’re reviewing a chest x-ray, it’s very important to remember to look around the edges of the film for non-chest pathology. This example is from a chest x-ray performed as part of the primary trauma series in a 22 year old girl who fell 200 feet off a cliff. While the lungs and mediastinum are fine, there are displaced fractures of both humeral necks (arrows). In this case, the skeletal abnormalities are fairly obvious, but serious shoulder injuries such as fractures and dislocations can be quite subtle on CXRs unless you remember to carefully search for them.