Traumatic Pneumatocele

A pneumatocele is defined as a thin-walled air-filled cyst of the lung most often seen in children after bacterial pneumonia. Traumatic pneumatocele, also referred as traumatic pulmonary pseudocyst or lung cyst, is a rare complication occurring 4% of the time after blunt chest trauma (mostly car accidents). Traumatic pneumatocele can also arise from continuous positive airway pressure mechanical ventilation. Represent air-filled lesions within the pulmonary parenchyma after laceration and recoil of the affected chest cage. It represents a greater transmission of energy to the lung and a more severe injury than pulmonary contusion by itself. Traumatic pneumatoceles occurs more commonly in children and young adults due to the pliability of the pediatric rib cage and relative increased fragility of the lung parenchyma. The condition is radiologically characterized by the appearance of pulmonary cavities with no epithelial lining filled with air, fluid or blood. Pneumothorax or pneumomediastinum might also coexist. Only 20% of associated patients have rib fractures. Any number of pneumatoceles can exist at any location except the apices of the lung. Though they are appreciated in simple chest films, CT-Scan is more accurate and sensitive in detecting them. The formed cavities filled with fluid, blood or air continues to increase in size until a balance of lung pressures is achieved between the cavities and the surrounding tissue. Pneumatoceles can be single, multiple, uniloculate or multiloculated, elliptical or spherical cavities. Symptoms include chest pain, dyspnea, cough, tinges of blood in sputum, mild fever or leukocytosis 12 to 36 hours after trauma. Fever and leukocytosis results from absorption of damaged lung tissue or blood clot and not from infection. Management of traumatic pneumatoceles is conservative as observation is what is required. They usually require several weeks to months to resolve in time. Prophylactic antibiotics usage is controversial. Surgical management is needed with large pneumatoceles associated with life-threatening hemoptysis, persistent infections, hematocele and respiratory compromise. 

References:
1- Yang TC, Huang CH, Yu JW, Hsieh FC, Huang YF: Traumatic pneumatocele. Pediatr Neonatol. 51(2):135-8, 2010
2- Cheung NK, James A, Kumar R: Large traumatic pneumatocele in a 2-year-old child. Case Rep Pediatr. 2013;2013:940189. doi: 10.1155/2013/940189. Epub 2013 Sep 25.
3- Matuszczak E, Oksiuta M, Hermanowicz A, Debek W: Traumatic pneumatocele in an 11-year-old boy - report of a rare case and review of the literature. Kardiochir Torakochirurgia Pol. 2017 Mar;14(1):59-62. doi:10.5114/kitp.2017.66934. Epub 2017 Mar 31.
4- Armstrong LB, Mooney DP: Pneumatoceles in pediatric blunt trauma: Common and benign.  J Pediatr Surg. 53(7):1310-1312, 2018
5- Schimpl G, Schneider U: Traumatic pneumatoceles in an infant: case report and review of the literature. Eur J Pediatr Surg. 6(2):104-6, 1996
6- Van Hoorebeke E(1), Jorens PG, Wojciechowski M, Salgado R, Desager K, Van Schil P, Ramet J: An unusual case of traumatic pneumatocele in a nine-year-old girl: a bronchial tear with clear bronchial laceration. Pediatr Pulmonol. 44(8):826-8, 2009



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