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Pneumonia Amongst Pneumonias: A Persistent Pneumatocele FREE TO VIEW

Manuel Jimenez*, MD; Ranjodh Singh, MD
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The Jewish Hospital, Cincinnati, OH

Chest. 2012;142(4_MeetingAbstracts):1006A. doi:10.1378/chest.1389362
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SESSION TYPE: Miscellaneous Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: A pulmonary pneumatocele is an air-filled, thin-walled pulmonary cavity that rarely presents in adults. Pneumatoceles have been reported as the result of acute pneumonia or trauma, although the definite etiology and pathogenesis is not completely understood. We describe the case of a female with a pneumatocele caused by neither trauma nor pneumonia that developed into a complex pneumatocele with necrotizing pneumonia.

CASE PRESENTATION: A 58 year old Caucasian female presented with a one-week history of right-sided chest pain, fever, and chills. Her past medical history was significant for a small pneumatocele diagnosed seven years ago. She denied any previous history of pneumonia or trauma. On examination she had diminished breath sounds in the right lower lobe. Her complete blood count was remarkable for a leukocyte count of 20,000 with 23% bands. The initial chest X-ray revealed a complex pneumatocele in the right lower lobe with air-fluid levels measuring 12 x 10 cm. A CT of the chest with contrast showed a cystic cavity in the right lower lobe measuring 8.7 x 9.2 cm. She was started on broad spectrum antibiotics. Subsequently a CT-guided aspiration and drainage was performed with 250 ml. of seropurulent content drained; after which a percutaneous catheter was placed. However, the cavity failed to involute and an air leak developed; which prompted the use video-assisted thoracoscopic surgery with resection of the pneumatocele. Haemophilus Influenzae was recovered from the fluid drained and pathologically the resected pneumatocele showed necrotic lung tissue. The patient’s symptoms and leukocytosis resolved after a full course of antibiotics. The chest tube was then removed and a follow-up chest X-ray confirmed the complete resolution of the affected lung.

DISCUSSION: Reportedly pulmonary pneumatoceles appear after acute pneumonia or trauma and tend to spontaneously resolve without significant sequelae. Although persistence of these cystic cavities up to three years has been identified, they do not typically endure seven years, as it did in this case. This case is also unique by the behavior of this pneumatocele, which continue to gradually expand over time until it presented as a complex necrotizing entity.

CONCLUSIONS: While pnemuatoceles rarely develop into pneumonia, clinicians should be aware of the potential complications of these seemingly benign intra-pulmonary structures.

1) T McGarry. Pneumatocele Formation in adult pneumonia. Chest 1987;92;717-720

2) M. J. Quigley. Pulmonary Pneumatocele: Pathology and Pathogenesis. AJR, June 1988;1275-1277

3) Mark W. Asplund. Successful Transthoracic Drainage of Infected Traumatic Pneumatocele. Chest 1986;90;788

DISCLOSURE: The following authors have nothing to disclose: Manuel Jimenez, Ranjodh Singh

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The Jewish Hospital, Cincinnati, OH




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