Hydropneumothorax is defined as the presence of both air and fluid within the pleural space.^[1] An upright chest x-ray will show air fluid levels. The horizontal fluid level is usually well defined and extends across the whole length of one of the hemithorax.

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Hydropneumothorax
A hydropneumothorax with a white arrow pointing to the lung's pleura
Specialty	Emergency medicine

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This can be remembered by the 4 'S': straight line dullness, shifting dullness, splash, sound of coin.

• Iatrogenic: Introduction of air during pleural fluid aspiration in effusion
• Presence of a gas-forming organism
• Thoracic trauma

Diagnosis can be via CXR. CT is better to outline borders of air fluid levels, however, CT has a greater radiation exposure.

Treatment includes ICD (intercostal drainage) of fluid and air and treatment of underlying conditions.