Medical image of the week: hydropneumothorax

• Main Authors: Saksouk B, Thao C, Luraschi C
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2015-09-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: hydrothorax; hydropneumothorax; esopageal perforation. complication; esophagram; CT scan; chest pain; esophageal-pleural fistula; treatment; differential diagnosis
• Online Access: http://www.swjpcc.com/imaging/2015/9/30/medical-image-of-the-week-hydropneumothorax.html

A 67-year-old woman who underwent a robotic laparoscopic surgical repair secondary to a large paraesophageal hernia with gastric volvulus. Post-operatively, she developed respiratory distress and a chest CT revealed a large right hydropneumothorax. A Gastrograffin esophagram was done showing Gastrograffin in the esophagus, stomach as well as in the right pleural space suggesting an esophageal-pleural fistula (Figure 1). A chest tube was placed and contrast was present revealing a esophageal-pleural fistula (Figures 2 and 3). Esophageal perforation should be considered in all patients with unexplained chest pain. Rapid recognition and diagnosis is key as delay in treatment is associated with increased mortality and morbidity (1). Causes of esophageal perforations include upper endoscopy, Boerhaave’s syndrome, foreign body ingestion, trauma, malignancy and intra-operative injury (2). Treatment depends on the location and the extent of the perforation as surgical intervention is the gold standard.