There is a hydropneumothorax. Notice the air-fluid level. The upper lobe is still attached to the chest wall by adhesions. Maybe this patient was treated for a prior pneumothorax. There is a lung cyst in the upper lobe. So we can assume that the pneumothorax has something to do with a cystic lung disease. Since this patient is a woman, lymphangioleiomyomatosis (LAM) is a possible diagnosis. LAM is a rare lung disease that results in a proliferation of smooth muscle throughout the lungs resulting in the obstruction of small airways leading to pulmonary cyst formation and pneumothorax. LAM also occurs in patients who have tuberous sclerosis. #Clinical #Radiology #CXR #Pneumothorax #Lymphangioleiomyomatosis #LAM #RadiologyAssistant