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Introduction: Tension pyopneumothorax is a rare, life-threatening condition that occurs as a complication of intrathoracic infection or bronchopleural fistula. In the few cases reported in the literature, the patients typically have multiple comorbidities, underlying lung disease, and/or an immunocompromised state.Case Report: This case describes tension pyopneumothorax in a previously healthy adolescent male with no existing risk factors for this disease. After emergent stabilization and admission, surgical exploration of the chest revealed no fistulas or pleural defects. Extensive workup did not show any underlying risk factors for development of this condition.Conclusion: This case of pyopneumothorax with progression to tension physiology is exceedingly rare. Uniquely, the patient had no underlying medical or anatomical predisposition to developing this condition. The case also emphasizes pediatric patients’ capacity to compensate in the setting of critical illness.

Objectives: People experiencing homelessness (PEH) have significant health needs and face significant obstacles when accessing health care. Hypertension can be a rough predictor of health care access; increased levels may reflect barriers to care. It is unknown whether problems stem from a lack of health insurance, as PEH enrollment data are scant, particularly in non-Medicaid expansion states. To begin to address existing literature gaps, we surveyed insurance status and collected blood pressure (BP) measurements of PEH presenting to a free clinic in Miami-Dade County, Florida. Study Design: We present trends from retrospective cohort data that include insurance status information and BP measurements obtained from 200 PEH receiving care at a free clinic. Methods: Recruitment encounters took place over 1 year. Participants were approached about the option of using deidentified data for research purposes and informed consent was obtained prior to being included in the study. Deidentified data were collected and stored in a Health Insurance Portability and Accountability Act-compliant REDCap then downloaded and analyzed in R 4.3.2. Results: A majority (61%) of PEH were insured. Mean (SD) systolic BP of uninsured PEH was 141.0 (23) mm Hg vs 135.4 (22) mm Hg for insured PEH. Independent 2-tailed t test found the mean systolic BP of insured PEH to be significantly lower than that of uninsured PEH (P = .00035). After stratifying the cohort into 10-year age groups (eg, 30-39 years, 40-49 years, etc), we discovered that uninsured participants aged 50 to 59 years had significantly increased systolic and diastolic BP. Conclusions: Insured PEH had lower systolic BP, despite an older mean age. After age stratification, a difference remained for those aged 50 to 59, representing the largest sample and oldest age group without Medicare. Still, the mean BP of insured PEH was elevated within range of hypertension, indicating that there are other barriers limiting the ability of PEH to access health care and that improvement is unlikely to be achieved solely by increasing insurance enrollment. Future studies should investigate additional factors, including why insured PEH choose free clinic care. [ABSTRACT FROM AUTHOR]