A hydropneumothorax (plural: hydropneumothoraces) (or less commonly pneumohydrothorax (plural: pneumohydrothoraces)) is the term given to the concurrent presence of a pneumothorax and pleural effusion (i.e. hydrothorax) (i.e. gas and fluid) in the pleural space.
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Pathology
It may arise in various situations which include
- thoracentesis 1,2
- thoracic trauma
- bronchopleural fistula
- esophagopleural fistula
Radiographic features
Plain radiograph
On an erect chest radiograph, recognition of hydropneumothorax can be rather easy - and is classically shown as a gas-fluid level. On the supine radiograph, this may be more challenging where a sharp pleural line is bordered by increased opacity lateral to it within the pleural space may sometimes suggest towards the diagnosis 3,4.
Ultrasound
Sonographic findings include 7;
-
hydro-point sign
- describes the interface of a pleural line which lacks lung sliding and an anechoic collection bounded inferiorly by the diaphragm
- coexistence of the sonographic signs characteristic of pneumothorax and a pleural effusion 6
- a lung point sign may also be found
- describes the interface of a pleural line which lacks lung sliding and an anechoic collection bounded inferiorly by the diaphragm
Differential diagnosis
For a gas-fluid level on plain radiograph consider:
- pyopneumothorax
- hemopneumothorax
- pulmonary abscess
- traumatic pneumatocele
- soft tissue abscess
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