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Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Laryngeal and/or tracheo- or broncho-stenosis may lead to hoarseness, stridor, obstructive emphysema or collapse. Hilar or mediastinal node enlargement is rare. Pleural fluid or thickening is uncommon, but may be gross. Occasionally a pneumothorax or a hydro-pneumothorax may result from rupture of a cavitating lung nodule.
Clinical Cases
Published in S. J. Copley, J. P. Kanne, D. M. Hansell, Thoracic Imaging, 2014
S. J. Copley, J. P. Kanne, D. M. Hansell
56i. The chest radiograph shows a multiloculated hydropneumothorax with gas in the chest wall. The CT shows volume loss within the right hemithorax, consistent with the patient’s surgery, and a complex collection in the right pneumonectomy space. There is also a segment of a tract, which extends from the bronchial stump to the pleural space (56c, arrow). The features are those of a bronchopleural fistula.
Optimal diagnostic strategies for pleural diseases and identifying high-risk patients
Published in Expert Review of Respiratory Medicine, 2023
D N Addala, P Denniston, A Sundaralingam, N M Rahman
Chest Radiograph (CXR) is amongst the most widely available radiological investigation. It is likely to provide first confirmation of the presence of fluid or air within the pleural space, as well as excluding differentials of breathlessness or chest pain. A postero-anterior (PA) CXR will detect around 200 mL of fluid within the pleural space and should remain the first radiological investigation in most cases[6]. Supine films are less useful for obvious reasons. CXR can also point toward causes of effusion, for example the presence of a lung mass or lymphadenopathy in the presence of a unilateral effusion which may indicate a malignant diagnosis. CXR is also useful following therapeutic thoracentesis to determine non-expansile lung in malignant pleural effusion. The presence of a hydropneumothorax with a clear air fluid level not respecting the lobar anatomy of the lung would sway one toward indwelling pleural catheter insertion rather than attempting pleurodesis as the definitive fluid control strategy.
Tension Hemopneumothorax in the Setting of Mechanical CPR during Prehospital Cardiac Arrest
Published in Prehospital Emergency Care, 2021
Dustin Rowland, Nicholas Vryhof, David Overton, Joshua Mastenbrook
The patient’s initial EKG showed ischemic changes, troponin was elevated, and an echocardiogram showed a depressed ejection fraction. This arrest was attributed to a cardiac event, however, cardiology recommended against taking the patient to the catheterization lab due to instability. The patient was admitted to the ICU. A chest x-ray the following day showed a small left-sided pneumothorax. A repeat CT of the chest showed a small left hydropneumothorax along with bilateral subcutaneous emphysema (Figure 3). The right-sided chest tube continued to drain approximately 100 mL of blood daily. Despite aggressive measures, the patient’s condition gradually worsened, with increasing vasopressor requirements, increasing lactate, and multi-organ failure. Given the patient’s poor prognosis, her family elected to withhold further escalation of care. The patient died approximately 48 hours after initial presentation.
A rare cause of recurrent hemopneumothorax
Published in Acta Clinica Belgica, 2020
Mike Ralki, Alaaddin Yilmaz, Jacques Vanwing, Kristof Cuppens
On admission, chest tomography showed presence of a hydropneumothorax on the right side with multiple thin-walled cysts and surrounding ground glass attenuation in the right middle lobe (Figure 1(a)). Pleural fluid analysis showed a bloody eosinophilic exudate without microbial or cytological anomalies. Our patient was referred for video-assisted thoracoscopic surgery due to the absence of definite diagnosis and the presence of persistent air leak despite thoracic drainage. Peroperative inspection revealed diffuse subpleural hemorrhagic cysts in the right middle lobe and a complete lobe resection was performed. Pleurodesis was not performed since the rest of the lung and the pleural membranes were normal. Pathologic examination of the resection specimen revealed an angiosarcoma (Figure 2).