Hydropneumothorax

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

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