INTRODUCTION: Extended Focussed Assessment with Sonography for Trauma (eFAST) has increasingly become the standard of care to identify hemo/pneumothorax, with a much greater sensitivity than a supine CXR (87% vs. 46%). Pneumothorax is recognized as a result of no "lung sliding", which occurs because the visceral and parietal pleural linings have separated. Symptomatic pneumothoraces are treated with tube thoracotomy. CASE PRESENTATION: 65 year old male presented to the trauma center after blunt chest trauma and hypotension. CXR did not show any obvious pathology, but eFAST failed to show any lung slide on the left chest. A left sided tube thoracotomy was performed after 1500mL of frank blood was initially evacuated; the entire lung was noted to be densely adherent to the chest wall; hemorrhage control was obtained by performing a pulmonary tractotomy/lobectomy of the involved lung segment, and the patient was then transferred to the SICU for ongoing resuscitation.

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