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Cardiothoracic Surgery |

A 20-Year-Old Man With Pulmonary Cavities Post Motor Vehicle Accident: Traumatic Pulmonary Pseudocyst

Sujith Cherian, MD; Subhraleena Das, MD; Hayas Haseer Koya, MD; Dona Varghese, MD; Rahat Hussain, MD
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University of Texas Health Science center at Houston, Houston, TX


Chest. 2013;144(4_MeetingAbstracts):99A. doi:10.1378/chest.1705224
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Abstract

SESSION TITLE: Surgery Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Traumatic pulmonary pseudocyst (TPP) is a rare clinical event that may occur following chest trauma. This complication usually occurs as a result of blunt trauma and rarely, due to a penetrating injury.

CASE PRESENTATION: A 20-year-old healthy male with no significant past medical history was brought to our institution after being involved in a high speed collision as a restrained driver. On arrival, he complained of only pain in the right side of the chest. Physical examination revealed no signs of respiratory distress, with oxygen saturations at 98% on room air, with tenderness over the anterior aspect of right side of chest. A chest X-ray was done (Figure 1), which was subsequently followed by CT scan of the chest (Figure 2). Chest X-ray revealed fractures of first to fourth ribs, with parenchymal opacity in the right mid lung zone and possible cavitation with an air-fluid level. Chest CT confirmed these findings and showed cavities with air fluid level in the right middle lobe, surrounded by areas of pulmonary contusion. With no evidence of underlying infection and given the clinical scenario the diagnosis of TPP was appropriately made. The patient remained asymptomatic during the hospital stay, and discharged the next day. 2 months into follow up, he is doing well.

DISCUSSION: TPP is a rare manifestation of thoracic trauma with a reported incidence of 0.34% in all thoracic traumas. Originally described by Fallon in 1940, it refers to the development of an air-filled or a fluid filled cavity without a true epithelial lining within the pulmonary parenchyma, usually after a high speed motor vehicle accident or fall. It can occur at almost any age, but the majority is <30 years of age with a male preponderance. Mechanism involves sudden shearing force across the pulmonary parenchyma leading to an area of pulmonary contusion. One -way communication between an airway and the contused area, leads to a pneumatocele formation within the area of contusion, which progressively increases in size till pressures are equalized. TPPs are generally self limiting and resolve in three to six months. Rarely, clinical course might be complicated by infection, bleeding or rupture into pleural space causing a pneumothorax. Such scenarios warrant more aggressive management with drainage and even resection in selected cases

CONCLUSIONS: Our case reiterates the rare occurrence of one of the complications of thoracic trauma, which if diagnosed appropriately can render many invasive interventions redundant

Reference #1: De Dios JA, Paoletti L, Bandyopadhyay T. A 27-year-old man with pleuritic chest pain and hemoptysis after a rugby game. Chest. 2009 Oct;136(4):1165-7

DISCLOSURE: The following authors have nothing to disclose: Sujith Cherian, Subhraleena Das, Hayas Haseer Koya, Dona Varghese, Rahat Hussain

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