Hydropneumothorax

Hydropneumothorax is defined as the presence of both air and fluid within the pleural space.[1] An upright chest x-ray will show air fluid levels. The horizontal fluid level is usually well defined and extends across the whole length of one of the hemithorax.

Hydropneumothorax
A hydropneumothorax with a white arrow pointing to the lung's pleura
SpecialtyEmergency medicine

Signs and symptoms

This can be remembered by the 4 'S': straight line dullness, shifting dullness, splash, sound of coin.

Causes
  • Iatrogenic: Introduction of air during pleural fluid aspiration in effusion
  • Presence of a gas-forming organism
  • Thoracic trauma

Diagnosis

Diagnosis can be via CXR. CT is better to outline borders of air fluid levels, however, CT has a greater radiation exposure.

Treatment

Treatment includes ICD (intercostal drainage) of fluid and air and treatment of underlying conditions.

References
  1. Clarke, Christopher; Dux, Anthony (2017). Chest X-rays for Medical Students. John Wiley & Sons. p. 82. ISBN 9781119426721. Retrieved 6 November 2017.
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