Oncological patient found with hydropneumothorax

Case discussion

Careful analysis of the radiograph revealed:

• Right hydro-pneumothorax causing a compressive effect on the right lung paremchyma and contralateral deviation of the median structures.
• Several pulmonary opacities with a blurred outline, oval, of variable size (the largest located in the left intercleidohilar area with a diameter of approximately 46mm and the right infrahilar area with a maximum diameter of 47mm).
• Bilateral perihilar and left basal alveolar infiltrates where they associate the erasure of the ipsilateral diaphragmatic outline (condensation process at the level of the left lower lobe - the presence of a minimal pleural effusion cannot be excluded).
• The cardio thoracic index is within normal limits, as can be seen from the automatic calculation made by the Rayscape algorithms.
  
  

Following the Rayscape automatic analysis and the interpretations of the radiologists, the patient is directed further to the appropriate multidisciplinary team in order to undergo the necessary treatment.

More info

A hydropneumothorax (plural: hydropneumothoraces) (or less commonly pneumohydrothorax (plural: pneumohydrothoraces)) is the term given to the concurrent presence of a pneumothorax and pleural effusion (i.e. hydrothorax) (i.e. gas and fluid) in the pleural space.

It may arise in various situations which include:

• thoracentesis
• thoracic trauma
• bronchopleural fistula
• esophagopleural fistula
• neoplastic lesions
  
  

For a gas-fluid level on plain radiograph, as differential diagnosis we can consider:

• pyopneumothorax
• hemopneumothorax
• pulmonary abscess
• traumatic pneumatocele
• soft tissue abscess