Hydropneumothorax

A left-sided hydropneumothorax (white arrow) with complete collapse of the left lung (black arrows)

Hydropneumothorax
the presence of both air and fluid within the pleural space. A hydropneumothorax may result from trauma, a spontaneous pneumothorax, a bronchopleural fistula, infection or rarely diffuse lung disease.
Spontaneous pneumothoraces are commonly accompanied by a very small pleural effusion which causes only blunting of the costophrenic angle. Occasionally tearing of adhesions between the visceral and parietal pleura causes a haemopneumothorax. Hydropneumothorax may be caused by a bronchopleural fistula; this may result from thoracic surgery (lobectomy or pneumonectomy), necrotizing infections (especially anaerobic, tuberculosis and fungi), pulmonary infarct, radiation, a subpleural neoplasm or rheumatoid nodule. Trauma is the commonest cause of a hydropneumothorax; the fluid component may be blood (haemopneumothorax), chyle (ruptured thoracic duct) or gastric contents (ruptured oesophagus). Iatrogenic causes of traumatic hydropneumothorax include central line or nasogastric tube malpositioning, thoracentesis and iatrogenic bronchopleural fistulae. The lung fluke Paragonimus westerami commonly produces hydropneumothorax which is frequently bilateral as the flukes penetrate the diaphragm and pleura. Other rare causes of hydropneumothorax include endometriosis chest involvement and lymphangiomyomatosis.

The erect chest radiograph demonstrates a pleural airfluid level with a well-defined, horizontal superior margin to the fluid component which usually extends across the whole width of the hemithorax. An underlying cause such as an associated pleural or pulmonary mass is occasionally seen but is better demonstrated by CT. It is important to distinguish a pleural airfluid level from airfluid levels within dilated loops of herniated bowel or lung (as in a lung abscess) and CT may be helpful in this regard.

Treatment is by chest tube drainage. If the hydropneumothorax is loculated CT guidance may be required.

Chest X-Ray reveals hydropneumothorax on the left side









one more Example:



X Ray Report
pneumothorax Left side(upper zone)
Lung air leack
Lung tissue can see