Effusive pneumothorax is an abnormal collection of air and fluid within the pleural space: blood, pus, or serous fluid. Thus, effusive pneumothorax can be categorized as hemopneumothorax, pyopneumothorax, or hydropneumothorax, depending on the type of fluid accumulation. Hydropneumothorax is a clinical condition defined by the presence of air and serous fluid within the pleura space. Hydropneumothorax is one of the common respiratory emergencies encountered in the emergency department in India. Etiologies can be classified into infectious and non‐infectious causes, among which tuberculosis being the most common one. Point of care ultrasound (POCUS) can help diagnose hydropneumothorax at the bedside rather than shift the patient for an X‐ray. Here, we describe a case of hydropneumothorax, which was diagnosed using POCUS by characteristic sonographic signs, namely “Hydro‐point” and “barcode‐hydro point‐sinusoidal sign.” Sonographic hydro‐point is the transition zone of the air‐fluid interface, which is seen in hydropneumothorax. Targhetta et al., in 1992, introduced the term “Hydro‐point” in lung ultrasound for diagnosing hydropneumothorax but has been under‐reported/unspoken much in the literature. With the use of POCUS, we diagnosed and stabilized the patient in the Emergency Department.
Effusive pneumothorax can be hemopneumothorax, pyopneumothorax, or hydropneumothorax depending on the type of fluid compartment within the pleural cavity. Hydropneumothorax is the abnormal collection of air and serous fluid within the pleural cavity. Here, we report a case of a 34-year-old male who presented to the emergency department with cough and breathlessness. We did bedside point-of-care ultrasound-assisted clinical evaluation as the patient was vitally unstable, which showed “hydro point” and “defective barcode sign,” which suggested hydropneumothorax. We present these clinical evaluation details, imaging/sonographic findings, and patient management in this case report.
Pneumomediastinum can be primary (spontaneous) or secondary to iatrogenic, traumatic, and non‐traumatic causes. The incidence of spontaneous and secondary pneumomediastinum is higher in patients with coronavirus disease 2019 (COVID‐19) compared to the general population. So, pneumomediastinum should be considered in the differential diagnosis of any patient with COVID‐19 presenting with chest pain and breathlessness. A high level of suspicion is required to diagnose this condition promptly. Unlike in other disease conditions, pneumomediastinum in COVID‐19 has a complicated course with higher mortality in intubated patients. No guidelines exist for managing pneumomediastinum patients with COVID‐19. Therefore, emergency physicians should be aware of the various treatment modalities besides conservative management for pneumomediastinum and life‐saving interventions for tension pneumomediastinum.
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