Left hydropneumothorax in a patient with acute epigastric pain: an important clue!

Excerpt

A 67-year-old female smoker with osteoporosis on weekly alendronate and occasional constipation, presented to the Emergency Department complaining of abdominal pain. The pain had started 2 h before, when having a loose bowel movement. It was localized to the epigastrium and radiated to the left side of her back. After a single episode of vomiting preceded by forceful retching, the pain suddenly intensified. While in the examination room, she started complaining of dyspnea. On examination, she looked pale, diaphoretic, and tachypneic. Her vital signs were as follows: BP 130/70 mmHg, HR 75 bpm, SO₂ 93%, T 35.4 °C. Lung auscultation revealed decreased breath sounds in the upper left field and bibasilar crackles. The abdominal examination was unremarkable. The ECG did not show any significant abnormalities. Laboratory tests showed leukocytosis of 20.600 with neutrophilia. Liver and kidney function tests, cardiac enzymes, amylase, and electrolytes were within normal limits. Arterial blood gases were pH 7.38, PaO₂ 75 mmHg, PaCO₂ 38 mmHg, and HCO₃ 22.5 mmol/L. …