Hydropneumothorax is defined as condition in which both air and fluid are present in the pleural cavity.
Causes of Hydropneumothorax
1. Trauma
2. Presence of gas forming organisms (Infection)
3. Introduction of air during pleural fluid aspiration in pleural effusion
4. Obstructive lung disease
5. Cystic lung disease
6. Malignancy
Clinical findings of Hydropneumothorax
Inspection and Palpation
•Tracheal and mediastinal shift to opposite side
•Diminished chest movement and diminished Vocal fremitus on affected side
•Bulging of lower intercostal spaces on affected side
Percussion
•Hyperresonance over the upper air containing part
•Stony dull over the lower fluid containing part. Upper border of stony dullness is horizontal.
•Shifting dullness is present
Auscultation
•Vocal resonance is reduced
•Metallic crepitations are heard over the air containing part
•Breath sounds are absent in the affected hemithorax (if no bronchopleural communication is present)
•Coin test is present over the upper air containing part
•Succussion splash can be elicited on the affected side
Diagnosis
Chest X-ray and CT shows air fluid level
Treatment
•Intercostal drainage of air and fluid
•Antibiotics should be given if infection is present.
•Treat underlying conditions like Tuberculosis by Anti-TB drugs