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Hydropneumothorax

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.


Presentation

Although a hydropneumothorax is not frequently mentioned in the medical literature [1], 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 [1] [2] [3] [4]. 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 [5]. 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 [1]. 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 [4]. In a small number of cases, an urticarial reaction and even anaphylaxis can occur once immune cells interact with the echinococcal cysts [4].

Dyspnea
  • In this article, we report a case of a 57-year-old male, who is a smoker as well as an alcoholic, with right-sided hydropneumothorax presenting with dyspnea, epigastric pain, hoarseness of voice, and features of shock.[atmph.org]
  • CASE REPORT A 62-year old man presented with chief complaints of left sided heaviness of chest and exertional dyspnea for 5 days. He was a non-smoker, non-diabetic, non-hypertensive and a farmer by occupation.[jpmsonline.com]
  • Thoracic surgery was consulted for possible video-assisted thoracoscopic surgery (VATS); however, because the patient was doing well without any complaints of dyspnea and without hypoxemia, the decision was made to defer the surgery until his immunosuppression[bmcpulmmed.biomedcentral.com]
Prolonged Expiration
  • However, vesicular breath sound with prolonged expiration was detected in the left hemithorax. Heart sound was normal. Abdomen was scaphoid with epigastric tenderness and sluggish peristaltic sound.[atmph.org]
Gangrene
  • Herniation of abdominal viscera is the most common sequel, with strangulation and gangrene as the most serious complication.[ncbi.nlm.nih.gov]
Weight Loss
  • CONCLUSION From our study, it could be concluded that most patients presented with symptoms and signs of cardiorespiratory distress along with cough, anorexia, and weight loss which alerted toward diagnosis.[ncbi.nlm.nih.gov]
Neglect
  • Spectrophotometric Analysis of Extracts of Rotting Autopsy Material Album - 2012 The Art of Surgical Malpractice MCD - 2012 Gradual Skeletal Myopathy MCD - 2012 Infected and Neglected... MCD - 2013 The Beauty of Decomposition MCD - 2013[spirit-of-metal.com]

Workup

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 [6]. 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 [6]. However, transthoracic sonography (TS) has shown to be an equally useful method in detecting pleural pathologies [7]. 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 [7].

Decreased Oxygen Saturation
  • Twenty minutes after an uneventful left lung lavage, the patient experienced increased peak airway pressure, decreased oxygen saturation and hypercarbia, despite ventilation with 90 per cent oxygen.[ncbi.nlm.nih.gov]
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]
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 [ edit ] This section is empty. You can help by adding to it . (November 2017) References [ edit ][en.wikipedia.org]
  • After treatment with a temporary chest drain and oral diethylcarbamazine citrate, there was dramatic relief of symptoms and radiological improvement. The patient has been symptom free with no features of recurrence through 8 months of follow-up.[ncbi.nlm.nih.gov]
  • A definite diagnosis of a destroyed lung was made, permitting appropriate modification of the treatment.[ncbi.nlm.nih.gov]
  • 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. [2] , [3] 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]

Prognosis

  • DISCUSSION Angiosarcoma is a malignant cancer that rarely occurs and has a poor prognosis. Angiosarcoma occurs at a male predominance, and mostly affects elderly people, although it can occur at all ages.[benthamopen.com]

Etiology

  • 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]
  • 10.1097/CPM.0b013e3182036235 Images in Pulmonary Medicine Abstract Author Information Authors Article Metrics Metrics Primary lung cancer rarely presents with pneumothorax, and when it does one needs to consider endobronchial obstruction as a possible etiology[pdfs.journals.lww.com]
  • Mycobacterial pleurisy is a common etiology of lymphocyte-rich pleural effusion, and is commonly caused by Mycobacterium tuberculosis ( 27 ).[kjronline.org]
  • Attention to the fluid characteristics may provide some clues regarding underlying etiology.[emcrit.org]

Epidemiology

  • Patient cohorts with different local epidemiologic features in Taiwan must be investigated in order to better understand the pathogenesis of NTM pleurisy.[kjronline.org]
Sex distribution
Age distribution

Pathophysiology

  • Key words: Pneumothorax, Iatrogenic, Garenoxacin, Chest drain Advertisement Journal of Molecular Pathophysiology SUBMIT YOUR ARTICLE NOW[scopemed.org]
  • The pathophysiology of pneumothorax ex-vacuo remains unclear. Several potential hypotheses have been proposed.[bmcpulmmed.biomedcentral.com]

Prevention

  • Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications.[ncbi.nlm.nih.gov]
  • Tube thoracostomy drainage and therapy with trimethoprim-sulphamethoxazole for seven months prevented reaccumulation of pleural fluid and improved the general condition but failed to expand the lung.[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]
  • Pagina 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.ro]

References

Article

  1. Kasargod V, Awad NT. Clinical profile, etiology, and management of hydropneumothorax: An Indian experience. Lung India. 2016;33(3):278-280.
  2. Fayed HE, Woodcock VK, Grayez J. Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma. BMJ Case Rep. 2013;2013:bcr2013009350.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.

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Last updated: 2018-06-22 06:44