Hydropneumothorax--an unusual complication of lung lavage

Hydropneumothorax is an uncommon but potentially fatal complication for a patient undergoing positive pressure ventilation. The case of a 23-year-old woman with severe asthma requiring lung lavage is described. Twenty minutes after an uneventful left lung lavage, the patient experienced increased peak airway pressure, decreased oxygen saturation and hypercarbia, despite ventilation with 90 per cent oxygen. A chest x-ray revealed mediastinal shift and a left sided pneumothorax. Drainage was carried out, revealing air and clear fluid in the pleural space. The importance of technical problems such as patient and endotracheal tube positioning, elimination of cross-spilling and cardiopulmonary effects of lavage are discussed.