Open Access Open Badges Case report

Pneumothorax Ex-vacuo or “trapped lung” in the setting of hepatic hydrothorax

Yan S Kim1*, Irawan Susanto1, Catherine A Lazar1, Ali Zarrinpar2, Patricia Eshaghian1, M Iain Smith1, Ronald Busuttil2 and Tisha S Wang1

Author Affiliations

1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at University of California, 10833 Le Conte Ave, Room 37-131 CHS, Los Angeles, CA, 90095, USA

2 Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, USA

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BMC Pulmonary Medicine 2012, 12:78  doi:10.1186/1471-2466-12-78

Published: 17 December 2012



Hepatic hydrothorax is a major pulmonary complication of liver disease occurring in up to 5-10% of patients with cirrhosis.

Case presentation

We report four observations of the development of pneumothorax ex-vacuo or trapped lung in the setting of hepatic hydrothorax. The diagnosis of trapped lung was made based on the presence of a hydropneumothorax after evacuation of a longstanding hepatic hydrothorax with failure of the lung to re-expand after chest tube placement in three of the four cases. Two patients underwent surgical decortication with one subsequent death from post-operative bleeding. The other two patients remarkably had spontaneous improvement of their “trapped lung” without surgical intervention.


While pneumothorax ex-vacuo is a known phenomenon in malignant effusions, to our knowledge, it has never been described in association with hepatic hydrothoraces. The pathophysiology of this phenomenon remains unclear but could be related to chronic inflammation with development of a fibrous layer along the visceral pleura.

Hepatohydrothorax; Trapped lung; Pnumothorax Ex-Vacuo; Pleural effusion