A hydropneumothorax is a term denoting the simultaneous presence of air and fluid in the pleural space. This clinical entity may be encountered in numerous conditions, including severe infections, trauma, and malignant diseases, with respiratory symptoms depending on the course and severity of hydropneumothorax, as well as accompanying respiratory changes. Plain X-rays are sufficient to make the diagnosis.
Although a hydropneumothorax is not frequently mentioned in the medical literature , its non-specific clinical appearance has been attributed to several conditions. Tumors, such as malignant pleural mesotheliomas (MPMs) and angiosarcomas, are documented as potential causes, whereas tuberculosis is designated as the most common infectious etiology of a hydropneumothorax, but hydatid lung disease caused by echinococcus granulosus is also reported as a possible cause    . On the other hand, invasive procedures of the lungs - thoracocentesis, placement of chest tubes and even a transbronchial biopsy all carry a risk for a post-procedural hydropneumothorax, suggesting their important role in the pathogenesis of this condition . The clinical presentation starts with an acute onset of respiratory insufficiency characterized by dyspnea, breathlessness and an overall decline in respiratory function, whereas additional signs of fever and constitutional symptoms (weight loss, malaise, anorexia) are often seen if tuberculosis is the underlying cause . Chest pain aggravated by deep breathing and a cough is reported in patients who suffer from hydatid disease, in whom cystic penetration into the pleural space causes hydropneumothorax . In a small number of cases, an urticarial reaction and even anaphylaxis can occur once immune cells interact with the echinococcal cysts .
CASE REPORT: A 97-year-old woman complained of acute dyspnea without prior vomiting. Chest x-ray study showed a large right pneumothorax with associated effusion. [read.qxmd.com]
It is typically diagnosed after patients present with nonspecific symptoms of chest pain, dyspnea, and cough with initial imaging most commonly showing unilateral pleural effusion. [ncbi.nlm.nih.gov]
Case contributed by Dr Aditya Shetty Diagnosis certain Diagnosis certain Presentation h/o dyspnea Patient Data Age: 30 Gender: Male From the case: Hydropneumothorax X-ray Frontal A large radiolucent area noted in the left upper and mid zone with a sharply [radiopaedia.org]
Abstract A 61-year-old man was admitted to the emergency room because of sudden right chest pain and dyspnea. A chest X-ray and chest computed tomography (CT) revealed severe right pneumothorax with massive pleural effusion. [jtd.amegroups.com]
Full Text A 15-year-old male came to the emergency department after 3 days with intense chest pain and dyspnea. [elsevier.es]
Although a hydropneumothorax is principally diagnosed through imaging studies, physicians can include it in the differential diagnosis of respiratory symptoms only after a thorough patient history and a physical examination focused on lung auscultation. Tachypnea, signs of cyanosis and an "inconclusive" lung sound heard at the level of hydropneumothorax formation should prompt the physician to order a plain chest X-ray, a procedure that will undoubtedly reveal an air-fluid level lined almost perfectly at a horizontal level, mimicking pleural effusion . Furthermore, signs of lung collapse and pleural effusion may be shown on plain radiography and computed tomography (CT), which is also recommended during workup, especially if radiography is not conclusive . However, transthoracic sonography (TS) has shown to be an equally useful method in detecting pleural pathologies . In fact, its cost-effectiveness and the ability to perform the procedure bed-side, favor its use over plain radiography, especially when only supine X-rays can be carried out due to the overall condition of the patient .
- Wuchereria Bancrofti
A pleural fluid report also showed eosinophilia and a few motile microfilaria of Wuchereria bancrofti. Microfilaria was also documented in peripheral blood. There was no evidence of other organ system involvement. [ncbi.nlm.nih.gov]
A pleural fluid report also showed eosinophilia and a few motile microfilaria of Wuchereria bancrofti... [read.qxmd.com]
- Nocardia Asteroides
A case of hydropneumothorax due to Nocardia asteroides in a patient with diabetes mellitus is reported. [ncbi.nlm.nih.gov]
- Coccidioides Immitis
The only organism grown from cultures of the lung and pleural fluid was Coccidioides immitis, confirmed by exoantigen testing. [ncbi.nlm.nih.gov]
Treatment Treatment is mostly the treatment includes ICD (intercostal drainage) of fluid and air and treatment of underlying conditions. [en.wikipedia.org]
Despite treatment, depending on the duration, severity, and expertise of the treatment center, mortality rates are nearly as high as 20-40% in treated and 100% in untreated cases. , Survival is directly related to the time of diagnosis and treatment [atmph.org]
Treatment is surgical removal in the former and ICT drainage in the latter. [doctor.ndtv.com]
Treatment depends on the location and the extent of the perforation as surgical intervention is the gold standard. [swjpcc.com]
INTRODUCTION Angiosarcoma is a rare aggressive malignancy that has a poor prognosis despite current intensive treatment [1-3]. This tumor can involve multiple organs, including the pleura. [openrespiratorymedicinejournal.com]
The overall prognosis can be variable, dependent on the underlying cause. [radiopaedia.org]
Etiologic diagnosis will guide prognosis and the selection of specific chemotherapy. [ncbi.nlm.nih.gov]
Prognosis In most cases, prognosis is poor with a perinatal mortality rate ranging from 55-98%, but it is influenced by numerous factors. The documents contained in this web site are presented for information purposes only. [orpha.net]
Extensive pleural fluid analysis is essential in establishing etiological diagnosis. TB is the most common etiology. ICD for long duration with antimicrobial chemotherapy is the management. [ncbi.nlm.nih.gov]
Patient cohorts with different local epidemiologic features in Taiwan must be investigated in order to better understand the pathogenesis of NTM pleurisy. [kjronline.org]
Knowledge of the epidemiology and clinical characteristics of maternal and fetal infection can be used to select a diagnostic approach. Etiologic diagnosis will guide prognosis and the selection of specific chemotherapy. [ncbi.nlm.nih.gov]
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Summary Epidemiology The incidence of IHF has decreased greatly since the introduction of RhoD immune globulin in the 1960's and has wide regional variability. The incidence in the U.K. is estimated to be at about 1/3,000 births. [orpha.net]
Osborn waves in myocardial ischemia in absence of hypothermia have been very well described as an early manifestation of left circumflex (LCx) artery infarction. Pathophysiologically, the heterogeneous distribution of a transient outward current-mediated [ijciis.org]
Pathophysiology, investigations, treatment and counseling are outlined. [intechopen.com]
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The pathophysiology of pneumothorax ex-vacuo remains unclear. Several potential hypotheses have been proposed. [bmcpulmmed.biomedcentral.com]
Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications. [ncbi.nlm.nih.gov]
Nasogastric intubation is associated with iatrogenic complications in up to 8% of the cases. 1 The most common ones are related to the respiratory system. 2 In order to prevent such accidents, the use of auxiliary techniques such as the capnography and [casereports.bmj.com]
Seite 223 - American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-662. [books.google.de]
- Kasargod V, Awad NT. Clinical profile, etiology, and management of hydropneumothorax: An Indian experience. Lung India. 2016;33(3):278-280.
- Fayed HE, Woodcock VK, Grayez J. Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma. BMJ Case Rep. 2013;2013:bcr2013009350.
- Chang JH, Kim JH, Hong S-H, et al. Angiosarcoma Presenting with Spontaneous Hydropneumothorax: Report of a Case and Review of the Literature. Open Respir Med J. 2014;8:48-54.
- Zefov VN, Almatrooshi MA. Chest X-ray findings in late-onset congenital diaphragmatic hernia, a rare emergency easily misdiagnosed as hydropneumothorax: a case report. Journal of Medical Case Reports. 2015;9:291.
- Boland GW, Gazelle GS, Girard MJ, Mueller PR. Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions. AJR Am J Roentgenol. 1998;170(4):943-946.
- Atay AE, Oruc M, Sayin T, Gullu MN. Urticaria and hydropneumothorax as an exceptional cause of ruptured hydatid cyst of lung. J Postgrad Med. 2013;59(4):328-330.
- Reissig A, Kroegel C. Accuracy of transthoracic sonography in excluding post-interventional pneumothorax and hydropneumothorax. Comparison to chest radiography. Eur J Radiol. 2005;53(3):463-470.