A 27 year old male with a history of osteosarcoma with numerous lung metastases s/p left upper lobe wedge resection 1 year ago presents with dyspnea on exertion and “abnormal findings on outpatient CT scan”. Vitals include HR 135, RR 18, SpO2 93% on room air. On exam, he has diminished but present breath sounds bilaterally. A chest x-ray is obtained and shown below. What’s the diagnosis?
Answer: Hydropneumothorax (see pleural line in periphery of left lung and pleural effusion)
- Defined as the presence of both air and fluid in the pleural space
- Can be either atraumatic or traumatic (hemopneumothorax)
- Underlying etiologies can include: COPD (due to presence of blebs), pneumonia, TB, malignancy, prior lung instrumentation
- Most common presenting symptoms are SOB and cough
- Diagnosis can be made on CXR, US, or CT
- In the event of tension physiology, treat as tension PTX with needle decompression, tube thoracostomy
- For more stable cases, treatment is supplemental O2 to help with lung re-expansion, tube thoracostomy, and pulmonology consultation
- Ultimately, requires admission for further workup, treatment of underlying condition
- The etiology of this patient’s hydropneumothorax was unknown, but possibly related to underlying malignancy
Kasargod V, Awad NT. Clinical profile, etiology, and management of hydropneumothorax: An Indian experience. Lung India. 2016;33(3):278-280.