Hydropneumothorax in man with history of alcohol abuse associated cirrhosis

A case report published in The New England Journal of Medicine describes the case of a 47-year-old man presented with shortness of breath for the last 2 days which later turned out be hydropneumothorax on examination through chest radiography. The men had a history of cirrhosis associated with alcohol abuse.

"A 47-year-old man with a history of cirrhosis associated with alcohol abuse presented with a 2-day history of shortness of breath. Before this symptom developed, he had been treated with repeated thoracentesis of the right side for cirrhosis-associated hydrothorax," report Ping-Hsien Chen, and Xi-Zhang Lin from National Cheng Kung University, Tainan, Taiwan.

Hydropneumothorax is defined as the presence of both air (pneumothorax) and fluid (hydrothorax) within the pleural space. An upright chest x-ray will show air fluid levels.

On pulmonary examination, breath sounds were absent on the right side, and a succussion splash was audible in the right upper chest when the patient was gently shaken. Chest radiography showed hydropneumothorax with a collapsed right lung and an adjacent thoracic air-liquid level, which was probably the result of repeated thoracentesis.

The patient was treated with chest-tube placement and diuretics. An analysis of the pleural effusion revealed transudative fluid without evidence of infection or cancer. The chest drain was removed 1 week later, after reexpansion of the lung.