Lung Pathology |

Rare Presentation of Pleuritic Chest Pain FREE TO VIEW

Kulothungan Gunasekaran, MBBS; Swetha Murthi, MBBS; Narmadha Panneerselvam, MBBS; Nazir Lone, MD; Karen McGinnis, MD
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Mary Imogene Bassett Hospital, Cooperstown, NY

Chest. 2015;148(4_MeetingAbstracts):623A. doi:10.1378/chest.2270703
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SESSION TITLE: Lung Pathology Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: High-energy blunt thoracic trauma can cause traumatic pneumatocele, which often becomes apparent within a few hours of trauma. We describe a case of delayed presentation of pneumatocele.

CASE PRESENTATION: 32 y.o female with h/o asthma was admitted for 2 weeks of pleuritic chest pain and SOB. She had actively participated in martial arts. O/E afebrile, tachycardic, tachypneic without rales or wheezes. She had an elevated D-Dimer. Chest XR (fig1b) and chest CT angiography (fig2) showed a large bulla in the right upper lung without an air fluid level and no pulmonary embolus. She continued to have respiratory distress and pleuritic chest pain despite symptomatic management. She underwent right-sided VATS for surgical resection of pneumatocele. Pathology showed benign ciliated cyst and normal underlying lung parenchyma. Her symptoms improved and she was discharged home after 3 days.

DISCUSSION: Traumatic pneumatocele is one of the rare complications of blunt chest trauma. The exact pathogenesis of pneumatocele is uncertain but is thought to be created by direct force injury to the lung parenchyma, resulting in rupture of small airways (1). Symptoms are often very mild and non-specific. Pleuritic chest pain, coughing and dyspnea may be noted. Differential diagnosis for symptomatic pneumatocele includes lung abscess, mycosis, tuberculous cavity, crack lung, bronchial carcinoma and bronchogenic cyst (2). Usually, this is a self-limiting disease that may spontaneously resolve in 2-4 months (1). Given the spontaneous remission, only symptomatic therapy is indicated. Failure of spontaneous remission in a symptomatic patient warrants image guided percutaneous intervention or surgical resection, which could be life saving and has been reported in the literature (3). In our case, the cyst was intraparenchymal and assumed to be expanding (fig 1a, 1b) resulting in severe respiratory distress. As a result, she underwent surgical resection of the pneumatocele and had an uneventful recovery.

CONCLUSIONS: Traumatic pneumatocele should be considered in the differential diagnosis of pleuritic chest pain complicating blunt chest trauma, especially in young adults.

Reference #1: 1. Tai-Ching Yang, Ching-Hua Huang et al. Traumatic Pneumatocele, Pediatrics & Neonatology, Volume 51, Issue 2, April 2010, Pages 135-138

Reference #2: 2. SEM Kolderman, S Fahrentholz et al. Netherlands Journal of Critical Care, volume 16, issue 6, December 2012, pages 226-228

Reference #3: 3. Daniel J DiBardino, R Espada et al. Management of complicated pneumatocele, The Journal of Thoracic and Cardiovascular Surgery, Volume 126, Issue 3, September 2003, Pages 859-861

DISCLOSURE: The following authors have nothing to disclose: Kulothungan Gunasekaran, Swetha Murthi, Narmadha Panneerselvam, Nazir Lone, Karen McGinnis

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