Left-sided hydropneumothorax in a young male: Importance of clinical and radiological markers in arriving at an aetiological diagnosis
A 30-year old male patient presented to the Accident &Emergency (A&E) Department with a history of left-sided chestpain since 4 hours. Following a bout of coughing, heexperienced a left-sided chest pain. The pain was diffuselypresent over the chest wall both anteriorly and posteriorly.There was no history of accompanying sweating, palpitationor vomiting. There was history of low-grade fever since onemonth which had now become high-grade since the past tendays. There was no other significant past medical history.
On general examination, the patient was tachypnoeic. Hispulse rate was 106/min, regular and of good volume. His BPwas 130/84 mmHg. On examination of the chest, the lefthemithorax moved less than the right. Percussion revealed ahyperresonant note over the left upper and mid zones, bothanteriorly and posteriorly, and a dull note over the left lowerzone posteriorly. On auscultation, there was absence of breathsounds on the left side anteriorly. However, tubular bronchialbreath sounds were heard in the left interscapular regionposteriorly and vocal resonance was also increased in thesame area. The right lung was normal. Chest x-ray showed aleft-sided hydropneumothorax with complete collapse of theleft lung (Figure 1). The mediastinum was shifted to the rightside. The right lung appeared to be normal. Four hours afteradmission, an intercostal drainage tube was inserted on theleft side in the 4th left intercostal space in mid-axillary line.About 500 ml of thick greenish-yellow fluid was drained. (copied from article)
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