Evaluation of Clinical background and yield of chest tube thoracotomy in hydropneumothorax , a pulmonologist point of view.

Document Type : Original Article


1 Pulmonologist, Department of Chest & TB, VMCH &RI Madurai

2 Radiologist, Department of Radiodiagnosis, SMBTIMS&RC Nashik


Introduction: The enlightenment of Hydro-pneumothorax arrived in former times of primitive Greece. It is a term which explains simultaneous existence of both free air and fluid (i.e., pneumothorax and hydrothorax) in the pleural space.The goal was to contribute and update the knowledge of clinical aspect as well as yield of diagnostic modalities in handling the cases of Hydropneumothorax.
Materials and Methods: Diagnosed cases of hydropneumothorax from casualty and routine OPD are considered. Detail of clinical background entered. Patients were subjected for analysis of sputum, blood and pleural fluid. Radiological investigation was done. Patients underwent tube thoracotomy procedure and observed till resolution.
 Results: Total 97 subjects had participated. Among them 76(78.35%) were men and 21 (21.64%) women. 91(93.85%) subjects had shortness of breath.  34 subjects (35.05%) had tuberculosis in the past.  Sputum smear AFB was positive in 19 subjects (19.58%). Plural fluid GeneXpert MTB was detected in 11 subjects (11.34 %) and MGIT Culture positive in 23(23.71%) subjects. Plural fluid gram stain culture was conclusive in 24 (24.74%) subjects. Pleural fluid ADA was raised in 74 (76.28%) subjects. Hypoxemia was observed in 46 (47.42%). In 38 (39.19%) cases chest tube was removed between 31 to 60 days.
 Conclusion: Tuberculosis turns up as the most common aetiology of hydropneumothorax and duration required for resolution is uncertain. Evaluation of pleural fluid (cytology, microbiological culture, biochemical measure) and Computed tomography were essential to reach aetiology of condition. Chest tube thoracotomy remains most practiced modality of treatment in hydropneumothorax. However advanced techniques have promising outcome and it’s an opportunity to research further.


  1. Aloosh O, Afshar H, Dadashpour N, Kiani A, Golestani Eraghi M. Idiopathic Exudative Hydropneumothorax and Spontaneous Pneumomediastinum in a Young Iranian Man: A Case Report. Journal of Cardio-Thoracic Medicine. 2017; 5(1):553-5.
  2. Thukral A, Tiwari DN, Sharma N, Tripathi K. Carcinoma of bronchus presenting as hydropneumothorax. JAPI. 2012 Apr; 60:56.
  3. Boland GW, Gazelle GS, Girard MJ, Mueller PR. Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions. AJR. American journal of roentgenology. 1998 Apr; 170(4):943-6.
  4. Fullana MJ, García BP, Pellicer CC. Pulmonary abscess and hydropneumothorax secondary to nocardiosis. Archivos de bronconeumologia. 1999; 35(7):360.
  5. Gao J, Yang C, Liu S, Yang S. Successful management on a case of dermatomyositis with hydropneumothorax, tracheoesophageal fistula and esophago‐thoracic cavity fistula. The Journal of dermatology. 2013 Aug; 40(8):678-9.
  6. Reed A, Dent M, Lewis S, Shogan P, Folio L. Radiology corner. Answer to last month's radiology case and image: hydropneumothorax. Military medicine. 2010 Aug; 175(8):625.
  7. Kasargod V, Awad NT. Clinical profile, etiology, and management of hydropneumothorax: An Indian experience. Lung India: Official Organ of Indian Chest Society. 2016 May; 33(3):278.
  8. Javed N, Aslam M, Mushtaq MA, Khan T, Shaheen MZ. Role of gene Xpert in diagnosis of tuberculous pleural effusion: comparison with pleural biopsy. European Respiratory Journal. 2014 Sep 1; 44(Suppl 58).
  9. Pravin KN, Chourasia E. Use of GeneXpert assay for diagnosis of tuberculosis from body fluid specimens, a 2 years study. J Microbiol Biotechnol. 2016; 1(1):000105.
  10. Verma SK, Dubey AL, Singh PA, Tewerson SL, Sharma D. Adenosine deaminase (ADA) level in tubercular pleural effusion. Lung India: Official Organ of Indian Chest Society. 2008 Jul; 25(3):109.
  11. Light RW. Pleural diseases. Lippincott Williams & Wilkins; 2007.
  12. Chakraborty A, Ramaswamy S, Shivananjiah AJ, Chikkavenkatappa N. The role of genexpert in the diagnosis of tubercular pleural effusion in India. Advances in respiratory medicine. 2019; 87(5):276-80.
  13. Kushwaha R, Shashikala P, Hiremath S, Basavaraj HG. Cells in pleural fluid and their value in differential diagnosis. Journal of cytology. 2008 Oct 1; 25(4):138.
  14. Goyal V.K, Agrawal Y, Tank R, Singh A. Role of Gene Xpert in Diagnosis of Tuberculous Pleural Effusion. Scholars Journal of Applied Medical Sciences, 2017; 5(11C):4467-4471
  15. Kao JH, Kao HK, Chen YW, Yu WK, Pan SW, Wang JH, Lien TC, Ho LI, Kou YR. Impact and predictors of prolonged chest tube duration in mechanically ventilated patients with acquired pneumothorax. Respiratory care. 2013 Dec 1; 58(12):2093-100.
  16. MacDuff A, Arnold A, Harvey J, Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010; Thorax 2010; 65(Suppl 2):ii18-ii31. Available from http://thorax.bmj.com