Traumatic Pulmonary Pseudocyst Research Articles

Wolf in sheep’s clothing: a case of primary lung adenosquamous carcinoma mimicking traumatic pulmonary pseudocyst

BackgroundTraumatic pulmonary pseudocyst is a rare “cystlike” lung lesion that typically develops following blunt chest trauma. It differs from lung cancer associated with cystic airspaces in terms of pathogenic mechanisms, clinical manifestations, and radiological features. Furthermore, there are few reports of the diagnostic bias between traumatic pulmonary pseudocyst and lung cancer associated with cystic airspaces. Here, we present a rare case of lung cancer associated with cystic airspaces that mimicks traumatic pulmonary pseudocyst.Case presentationA 61-year-old man with no chest medical or surgical history, no chest radiologic examination within the last five years, and no smoking history had an air-filled “cystlike” lesion surrounded by solid components and ground-glass opacities in the middle third of the right upper lobe of the lung during a computed tomography evaluation following blunt chest trauma. He was initially diagnosed with traumatic pulmonary pseudocyst and treated conservatively. On the third post-trauma day, he experienced hemoptysis, which was successfully treated with intravenous hemostatic medication. On the ninth post-trauma day, he exhibited a significant hemoptysis and a moderate dyspnea. A subsequent chest computed tomography scan demonstrated that the solid components had entered the lesion’s cavity and significantly expanded, and the surrounding ground-glass opacities had slightly enlarged. A contrast-enhanced chest computed tomography scan and a three-dimensional reconstruction computed tomography image confirmed that the solid components were a hematoma caused by damage to the right upper pulmonary vein. A right upper lobectomy was performed based on the concern about severe intrapulmonary bleeding. An intraoperative frozen section analysis showed significant bleeding in the lung parenchyma. Adenosquamous carcinoma was unexpectedly identified during the postoperative pathological examination of the resected specimen. A diagnosis of primary lung adenosquamous carcinoma was made. He was discharged on the seventh postoperative day and followed up for two years without any recurrence.ConclusionsThe potential of lung cancer associated with cystic airspaces should be considered for “cystlike” lung lesions discovered in elderly patients after blunt chest trauma. A comprehensive review of the medical history, meticulous analysis of the radiological findings, and close monitoring can help clinicians reduce the risk of diagnostic bias.

Traumatic pulmonary pseudocyst a case report: surgery? Follow-up?

Traumatic pulmonary pseudocysts represent uncommon parenchymal sequelae ensuing from thoracic trauma, typically arising subsequent to blunt force trauma. Generally benign in nature, these lesions frequently resolve spontaneously without necessitating specific therapeutic interventions. The significance of these acute cystic formations lies in the potential for misinterpretation by clinicians unfamiliar with their characteristics, leading to erroneous diagnoses such as malignancies or benign lung lesions. In this case report, we wanted to show that traumatic pulmonary pseudocysts, even if large in size, can resolve with follow-up without the need for surgery.

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

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.

Case of traumatic pulmonary pseudocysts coinciding with vertebral fracture.

Here, we report a case of traumatic pulmonary pseudocysts (TPPs) coinciding with vertebral fracture. Traumatic pulmonary pseudocysts (TPPs) are rare complications of blunt chest trauma. These clinical images of CT, presenting here, seemed to be valuable because they show the process of pseudocyst formation.

Multimodality diagnostic imaging findings in a dog with a traumatic pulmonary pseudocyst.

Multimodality diagnostic imaging findings in a dog with a traumatic pulmonary pseudocyst.

Unusual cavitary lesions of the lung: Analysis of patients with traumatic pulmonary pseudocyst.

OBJECTIVE:In this study, we aimed to draw attention to traumatic pulmonary pseudocysts, which are rare cavitary lesions resulting from thoracic trauma, and review the diagnostic and therapeutic approaches and results.METHODS:Between January 2014 and January 2017, 30 patients included in this study who were diagnosed with traumatic pulmonary pseudocysts, from 582 patients who were admitted to our hospital with blunt thoracic trauma. To obtain data from the hospital information management system of patients included in this study, permission was obtained from the medical specialization board and the data were analyzed retrospectively.RESULTS:The mean age of the patients with traumatic pulmonary pseudocysts was 40.8 years (range, 7–75 years), and 11 (36.7%) of the patients were under the age of thirty and 19 (63.3%) were over the age of thirty. Twenty-eight (93.3%) patients had lung contusion and among those who had traumatic pulmonary pseudocysts diameter less than 2 cm, in 10 (33.3%) patients, contusion was present. In 27 patients, TPP was seen in thoracic computed tomography and diagnosed in the first 12 hours, but only in 10 of these patients, traumatic pulmonary pseudocysts was seen on chest x-ray. The extrathoracic injury was found in 15 (50%) patients. Twenty-two (73.3%) patients underwent tube thoracostomy. No patient required a thoracotomy.CONCLUSION:Traumatic pneumatoceles are benign lesions and most of them regress with symptomatic treatment and supportive therapy without any specific treatment.

Blunt and Penetrating Traumatic Pulmonary Pseudocyst: Different Clinical Entities

Beattie, Genna MD; Cohan, Caitlin MD; Yasumoto, Eric MD; Victorino, Gregory P. MD, FACS Author Information

Computed tomography features of traumatic pulmonary pseudocysts

Objectives: To discuss the radiological characteristics of traumatic pulmonary pseudocyst (TPP) detected by thorax computed tomography. Methods: Retrospective screening was made of 107 patients applied with thorax computed tomography due to blunt thoracic trauma between 2014 and 2017 at our hospital. Results: TPP was detected in 6 (5.6%) patients. The patients comprised 5 males and 1 female with a mean age of 28 years (range, 15-49 years). Blunt thorax trauma was caused by traffic accidents in 4 patients and a fall from height in 2 patients. Eleven (64.7%) of the lesions were located in the lower lobes. The most common finding associated with TPP was ground glass opacities, which were present in all of the patients and represented the parenchymal contusion. Conclusion: Thorax computed tomography is an effective and reliable method for early and definitive diagnosis of the rare development of TPP after blunt thoracic trauma.

Surgical treatment for an infected traumatic pulmonary pseudocyst

: We herein report successful surgical treatment for a patient with infected traumatic pulmonary pseudocyst. A healthy 41-year-old male patient was transferred to our hospital due to traumatic head and chest injuries. On hospital day 9, follow-up computed tomography revealed infected pulmonary pseudocyst localized in right lower lobe. Despite of antibiotics administration, the patient did not recover from the infection. Therefore, surgical resection was planned. Right lower lobectomy was performed via posterolateral thoracotomy. The resected pulmonary pseudocyst contained frank pus caused by multidrug-resistance bacteria. The patient was transferred to other hospital for the rehabilitation after his general condition became stable.

Traumatic pulmonary pseudocyst: a rare complication of blunt thoracic injury.

Traumatic pulmonary pseudocyst is a rare and underreported complication of blunt chest trauma. It represents air trapped within a pulmonary laceration. It generally appears on radiographs as a thin-walled, air-filled cavity, with or without air-fluid levels. It is very important for emergency physicians and pediatricians to be familiar with this condition because it generally represents a benign, self-limited condition that only requires observation. We report a case of a young man admitted in our ICU for thoracic injury consecutive to a motor vehicle accident. The chest X-Ray showed multiple large thin-walled cystic lesions. The Chest CT identified several large cavities on the right lung confirming the diagnosis of traumatic pulmonary pseudocysts. He was treated by oxygen therapy and analgesia. His condition was relatively stable and improved after few days. He was discharged 10 days later and a follow-up chest CT showed spontaneous resolution of the pseudocyst.

Diagnosis and prognosis of traumatic pulmonary pseudocysts.

Traumatic pulmonary pseudocysts (TPP) are rarely talked about, developing in less than 3% of patients with pulmonary parenchymal injuries. Resolution usually occurs within a few weeks to a few months. A retrospective study was undertaken in 30 cases treated in Antalya Training and Research Hospital, Turkey, from January 2014 to December 2017. The 30 patients with TPP were 28 males (93.3%) and 2 females (6.7%) aged 14-64years (mean age 31.9years). Most of them are located in the right lower lobe (50%). The mean size of TPP was 2.07cm. The overall resolution time for TPP was found to range from 8 to 124days with a mean of 45.1 ± 32.9days. Computed tomography (CT) is a more beneficial than chest radiograph for early diagnosis. Physicians should control follow-up chest radiograph or CT scans until the pseudocyst resolves. Conservative treatment is acceptable in most cases, but intervention may be necessary if complications show up.

Traumatic Pulmonary Pseudocyst Mimicking a Congenital Cystic Lung Disease

Traumatic pulmonary pseudocyst (TPP) is a rare entity that occurs following a trauma to the chest. It usually presents as multiple cystic lesions on thoracic imaging. It is treated conservatively and tends to completely resolve after few months. In the absence of striking signs of trauma such as rib fractures, TPP can be mistaken for other cystic lung diseases. We present a case of TPP in a 17-year-old male who was seen for mild hemoptysis after falling off a cliff. The extent of his right lower lobe cystic lesions along with the lack of major signs of trauma led to an incorrect diagnosis of congenital pulmonary airway malformation. The patient was considered for lobectomy, which he refused. Imaging of the chest repeated one and three years later showed complete resolution of the lesions.

胸腔鏡補助下気管支縫合術を施行した外傷性仮性肺嚢胞の1例(A case of traumatic pulmonary pseudocyst treated by bronchial suture via video assisted thoracic surgery)

要旨 症例は24歳の男性。バイク運転中に大型トラックと衝突しタイヤに胸部を圧挫された。右胸部の圧痛と皮下気腫があり，少量の喀血を認めた。気胸と診断し胸腔ドレーンを挿入した。CTで右肺上葉に5×10cmの仮性肺嚢胞を伴う肺挫傷と血気胸，第4–7肋骨骨折を認めた。喀血と気漏は軽度で胸腔ドレナージによる保存的治療を行った。再検したCTで右気管支B3b入口部の断裂と肺嚢胞に交通を認め，気胸の増悪と新たな無気肺も認めた。Spike feverを認め，気管支損傷部の自然治癒は困難と判断し，第3病日に胸腔鏡補助下気管支縫合術を施行した。合併症なく術後10日目に退院した。外傷性仮性肺嚢胞は比較的稀であるが，多くが自然治癒する。肺膿瘍や気漏，気道出血が持続する場合に手術適応とされ，肺部分切除や葉切除が行われる。中枢側の気管支損傷を伴う肺嚢胞は感染リスクが高く，早期の気管支修復が肺の温存と感染予防に有効である。

A Case of Traumatic Pulmonary Pseudocysts Surgically Operated on for Associated Intractable Air Leak and Infection

A Case of Traumatic Pulmonary Pseudocysts Surgically Operated on for Associated Intractable Air Leak and Infection

Traumatic pulmonary pseudocysts mimicking a congenital malformation of the lung

Abstract Traumatic Pulmonary Pseudocysts (TPPs) are a rare consequence of thoracic trauma that is seen disproportionately in young adults and paediatric populations. In this case report, we detail a case of a TPP initially misdiagnosed on imaging as a Congenital Cystic Adenomatoid Malformation (CCAM). Conservative management and monitoring for resolution of TPP is highly effective as in most cases it self-resolves without issue or need for intervention. This contrasts with the surgical treatment often indicated for symptomatic CCAMs. Clearly, failure to recognize TPP as a rare but important differential of pulmonary cystic lesions in the context of trauma can lead to significant distress for the patient's family, over investigation and unnecessary or harmful interventions. We also review in this article the literature surrounding the radiological appearances, clinical features and management of both conditions.

Case Report of a Delayed Diagnosis of a Traumatic Pulmonary Pseudocyst in an Adult

Case Report of a Delayed Diagnosis of a Traumatic Pulmonary Pseudocyst in an Adult

Clinical Features, Diagnosis, and Treatment of Traumatic Pulmonary Pseudocysts

Traumatic pulmonary pseudocysts (TPP) are rare complications of blunt chest trauma. The aim of this study is to increase the understanding of this rare entity with imaging and clinical parameters for preventing complications and determining the correct treatment approach by observing 15 cases. We retrospectively reviewed the medical data and thoracic computed tomography scans of 185 patients who underwent examinations in our department after chest trauma between July 2014 and December 2015. Fifteen patients had TPPs, and their clinical features and imaging findings were evaluated. Their average age was 26.33 (range, 1-89) years. The cause of TPP was traffic accident in 13 patients and falling from a height in two. Tube thoracostomy was required in five patients. None of the patients required thoracotomy, and 66% of them recovered without any complications. Five patients died because of serious concomitant injuries. Sudden shearing force across the pulmonary parenchyma results in an area of pulmonary contusion and airtransfer from the airway to the contused area, which in turn leads to pneumatocele formation. Conservative treatment is recommended for these patients, but complications can occur because of cyst rupture. Patients should be closely monitored and be made aware of the risk of life-threatening complications.

難治性出血を合併した外傷性肺囊胞の1例

難治性出血を合併した外傷性肺囊胞の1例

初療室でECMOを導入し，救命し得た重症多発外傷の2症例(Two case of polytrauma patients with extracorporeal membrane oxygenation introduced in ER)

要旨平成22年人口動態統計によると，外傷死亡者の傷病部位として胸部外傷は頭部外傷に次いで多い 。胸部外傷を伴う多発外傷患者が，大量輸液・輸血や凝固障害により，他部位の止血処置中に著しい低酸素血症に陥ることは，重症例では稀ではない。これまで，胸部外傷によるsecondary ARDSに対するextracorporeal membrane oxygenation（以下，ECMO）導入の報告は散見されるが，病院到着から数時間以内の超急性期に初療室でECMOを導入することで，良好な経過をたどった2症例を経験したため報告する。症例1は，重症肺挫傷に対する下葉切除中の低酸素血症，低換気に対して術中にECMOを導入した。症例2は，重症骨盤骨折，腸管損傷に肺挫傷を合併し，腹部骨盤手術中に喀血し呼吸不全に陥ったため，ECMO実施下に止血を行った。2症例とも肺実質内に造影剤の血管外漏出像を認め，さらに他部位に複数箇所の止血を要する多発外傷例であり，ECMO導入により止血まで十分な酸素化が得られた。外傷症例に対して，来院から数時間以内に初療室においてECMO導入を速やかに行い，呼吸を担保しつつ止血術を行うことで救命し得た。外傷は，止血が得られれば引き続く集学的治療で十分可逆的な病態もあるため，救命手段の一つとして初療室でのECMO導入は有用な可能性がある。

Traumatic pulmonary pseudocysts after blunt chest trauma: Prevalence, mechanisms of injury, and computed tomography findings.

Traumatic pulmonary pseudocyst (TPP) is a rare complication of blunt chest trauma and closely related with severe injury. However, it has been poorly documented. We present a retrospective review of TPP cases treated at our hospital. The medical records and chest computed tomography scans of patients with TPP treated from January 2010 to December 2013 were retrospectively studied. A total of 978 patients underwent chest computed tomography for blunt chest trauma during the study period, and 81 (8.3%) had a total of 150 TPPs. The most common mechanism of injury was being struck by a motorized vehicle (n = 25, 30.9%). The mean (SD) Injury Severity Score (ISS) of the 81 patients was 33.2 (11.4). The prevalence of TPP was higher in younger patients (p = 0.011), but the total number of fractured ribs was significantly lower (p = 0.001). In a subgroup analysis performed according to pseudocyst location, the intraparenchymal group had more severe injuries than the subpleural group (ISS, 23.3 vs. 32.4, p < 0.001; chest Abbreviated Injury Scale [AIS] score, 3.4 vs. 4.0, p < 0.001; number of associated injuries, 2.9 vs. 4.0, p = 0.001). By multivariate analysis, ISS, age, and number of associated injuries were significantly different in these two groups (p = 0.038, p = 0.006, and p = 0.045, respectively). The prevalence of TPP among cases of blunt chest trauma was 8.3% and was higher in those struck by a vehicle and younger patients. Intraparenchymal pseudocyst was found to be related to more severe injuries. TPP was a self-limiting condition that does not require specific treatment. Prognostic/epidemiologic study, level IV.