Case contributed by Mostafa Elfeky
Diagnosis almost certain


History of chest infection and cough for one month, presented with chest pain and blood-tinged sputum for one day. No trauma.

Patient Data

Age: 30 years
Gender: Male

On presentation


Marked right pneumothorax with air-fluid level at the lower part of right hemithorax.

Partially collapsed right lung. Minimal mediastinal shift towards left side is noted.

Sharpening of left mediastinal border, suggestive of pneumomediastinum.

The patient was stable and referred to hospital for insertion of an intercostal tube.

After two weeks of intercostal tube removal, the patient had recurrent symptoms of chest pain. Then, CT was performed.


Marked right hydropneumothorax with partial collapse of the right lung.

Right apical pulmonary subpleural blebs are seen.

A small air collection around the upper trachea, suggestive of a tracheal diverticulum.

Incidental note of right upper calyceal small stone.

Case Discussion

On presentation, there was hydropneumothorax with associated pneumomediastinum. It is mostly spontaneous and may have occurred secondary to ruptured pulmonary bleb as some are seen at the right lung apex. Also, they may be responsible for recurrent hydropneumothorax.

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