Fluid and air in the lung.

A 52 year old presented to the outpatient department with one week history of shortness of breath.

The family medicine resident text me the below Chest XR (Apologies for quality but we have film XR in Sierra Leone)


My first response “did have have any trauma”

I was taught this pathognomic for hemopneumothorax. You would normally expect to see a curve to the fluid on the right hand of the chest, if you look closer you can see the absent lung markings which pneumothorax.

On POCUS we can confirm lack of lung sliding sliding on right lateral aspect of chest.

However, on the right inferior aspect where we would suspect fluid we see this


In these we see the black fluid as expected for pleural effusion and the characteristic flap of lung, however the speckled material demonstrates a complex effusion.


The patient went on to a chest drain, it was suspected to have underlying lung condition such as tuberculosis but unfortunately patient was lost to follow up.