Clinical profile, etiology, and management of hydropneumothorax: An Indian experience

Abstract

Introduction:Hydropneumothorax is an abnormal presence of air and fluid in the pleural space. Even though the knowledge of hydro-pneumothorax dates back to the days of ancient Greece, not many national or international literatures are documented.Aim:To study clinical presentation, etiological diagnosis, and management of the patients of hydropneumothorax.Materials and Methods:Patients admitted in a tertiary care hospital with diagnosis of hydropneumothorax between 2012 and 2014 were prospectively studied. Detailed history and clinical examination were recorded. Blood, pleural fluid, sputum investigations, and computed tomography (CT) thorax (if necessary) were done. Intercostal drainage (ICD) tube was inserted and patients were followed up till 3 months.Results:Fifty-seven patients were studied. Breathlessness, anorexia, weight loss, and cough were the most common symptoms. Tachypnea was present in 68.4% patients. Mean PaO2 was 71.7 mm of Hg (standard deviation ±12.4). Hypoxemia was present in 35 patients (61.4%). All patients had exudative effusion. Etiological diagnosis was possible in 35 patients by initial work-up and 22 required CT thorax for arriving at a diagnosis. Tuberculosis (TB) was etiology in 80.7% patients, acute bacterial infection in 14%, malignancy in 3.5%, and obstructive airway disease in 1.8%. All patients required ICD tube insertion. ICD was required for 24.8 days (±13.1).Conclusion:Most patients presented with symptoms and signs of cardiorespiratory distress along with cough, anorexia, and weight loss. Extensive pleural fluid analysis is essential in establishing etiological diagnosis. TB is the most common etiology. ICD for long duration with antimicrobial chemotherapy is the management.

A unique case of hydropneumothorax in allergic bronchopulmonary aspergillosis

“…Hydropneumothorax is defined as the abnormal presence of air and fluid in the pleural space. A recent cohort study [6] conducted in an Indian tertiary care center evaluated fifty-seven patients with non-traumatic hydropneumothorax. Tuberculosis was found to be the commonest etiology, followed by bacterial infections and pleural or pulmonary malignancies.…”

The Hippocratic Splash

“…Common causes of hydropneumothorax include trauma, iatrogenesis following thoracentesis and the presence of gas-forming organisms which are normally rare [3] . Other causes include tuberculosis and malignancy [1] .…”

“…Breathlessness followed by chest pains are the most common presenting symptoms in these patients. Fever, cough and constitutional symptoms such as weight loss and anorexia could be due to other specific aetiologies such as infection or malignancy [1] . Physical examination demonstrates significantly decreased or abolished breath sounds, dullness in a straight line (over the fluid), shifting dullness, a succussion splash and a positive coin test [5] .…”

“…Hydropneumothorax is characterized by the presence of air and fluid in the pleural cavity [1] . Current medical literature is scarce although this clinical entity was documented in the 19th century; indeed, the Hippocratic succussion splash was used in ancient Greek medicine in the 5th century BC [1, 2] . Hydropneumothorax is an infrequent presentation in the emergency room (ER) but can be life threatening.…”

Does serratiopeptidase prevent thoracic surgery in patients of hydropneumothorax of tubercular aetiology?

“…Hydropneumothorax per say does not cause severe chest pain. [ 1 ] In this study, patients were categorized into two groups based on the severity of chest pain (severe versus non-severe). The distinction between chest pain attributable to the disease pathology versus that stemming from intercostal drainage tube insertion remains unclear and so does the absence of a standardized pain scale or grading system for assessing chest pain severity.…”