Rapid enlargement of a traumatic pulmonary pseudocyst following an intraoperative leak test: a case report

Abstract

BackgroundTraumatic pulmonary pseudocysts are a rare complication resulting from pulmonary contusion associated with blunt chest trauma.Case presentationA 17-year-old male patient underwent emergency surgery for hemostasis of a traumatic lung injury caused by a car accident. Because the bleeding was from the peripheral lung, partial resection was performed with an automated suture machine. A routine leak test (positive pressure ventilation at 20 cm H2O) was performed as a precautionary measure. Postoperative imaging revealed rapid enlargement of a comorbid traumatic pulmonary pseudocyst. The collapse of the obliterating bronchus due to the accident and the intraoperative positive pressure ventilation for the air leak test were considered to have caused the rapid enlargement of the traumatic pulmonary pseudocyst. A thoracoscopic right lower lobectomy was performed on postoperative day 5. The patient had an uneventful postoperative course.ConclusionsTo our knowledge, this is the first report of a rapidly enlarging traumatic pulmonary pseudocyst captured on preoperative and postoperative computed tomography. It would serve as a learning point for respiratory surgeons. These results suggest that when patients with traumatic pulmonary pseudocysts are operated on under general anesthesia, excessive positive pressure ventilation may cause a rapid expansion of the pulmonary pseudocyst.