Hydropneumothorax

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.

Pathology

It may arise in various situations which include

Radiographic features

Plain radiograph

On an erect chest radiograph, recognition of hydropneumothorax can be rather easy - and is classically shown as a gas-fluid level. On the supine radiograph, this may be more challenging where a sharp pleural line is bordered by increased opacity lateral to it within the pleural space may sometimes suggest towards the diagnosis .

Ultrasound

Sonographic findings include ;

  • hydro-point sign
    • describes the interface of a pleural line which lacks lung sliding and an anechoic collection bounded inferiorly by the diaphragm
      • coexistence of the sonographic signs characteristic of a pneumothorax and a pleural effusion 
    • a lung point sign may also be found

Differential diagnosis

For a gas-fluid level on plain radiograph consider: