Thick, calcified visceral and parietal pleural rind with split pleura sign compatible with prior tuberculous empyema. Extrapleural fat proliferation and rib thickening are sequelae of chronic inflammation. The small volume of the right lung suggests trapped lung. In this situation, hydropneumothorax commonly follows pleural aspiration due to the abnormally low pleural pressure. Gas can enter the pleural cavity through an aspiration device or through pleural micro-tears.