This is a case of an esophageal perforation with subsequent formation of a large hydropneumothorax.

The patient underwent a left-sided video-assisted thoracic surgery with decortication, esophagogastroduodenoscopy, and bronchoscopy. He was found to have an area of exudate in the distal third of esophageal mucosa, which likely corresponded to a possible perforation. "Coffee ground" material was seen in mid to distal esophagus and stomach, likely relating to hematemesis. A total decortication was then performed. Approximately 4 L of grossly purulent, malodorous liquid was evacuated from the left pleural space and was sent for culture, chemistry, and cytology. Bronchoscopy was performed to ensure the airways were patent. The lung was witnessed to expand normally after evacuation of the fluid.

Co-authors:
Morgan Zhao, MD
Camille Dumas, DO