Traumatic pulmonary pseudocysts

Differences in clinical characteristics and outcomes for blunt versus penetrating traumatic pulmonary pseudocysts

INTRODUCTION

Traumatic pulmonary pseudocysts (TPPs) are under-reported in blunt trauma and rarely reported in penetrating trauma. Little is known about the impact of injury mechanism on the pathophysiology or the risk factors that predispose to worse patient outcomes. We hypothesized that blunt and penetrating TPPs have different clinical characteristics and outcomes.

METHODS

Computed tomography imaging was evaluated for patients presenting at a level 1 trauma center with confirmed TPP from 2011 to 2018. Diameter was determined by largest dimension of the dominant TPP. Clinical variables and TPP features were compared for blunt versus penetrating trauma by using comparative statistics and multivariable analysis.e RESULTS: A total of 101 TPP patients were identified (blunt = 64; penetrating = 37). In penetrating TPP, rates of concomitant pulmonary laceration, hemothorax, and pneumothorax, were, respectively, 4.5, 3.1, and 1.4 times higher than for blunt TPP. Concomitant rib fracture was twice as common in blunt TPP as in penetrating TPP (69% versus 32%). For penetrating injury, the risk of complications related to TPP was increased (aOR = 5.3), specifically persistent/recurrent pneumothorax (aOR = 10.4). All deaths resulted from pulmonary hemorrhage (blunt = 3, penetrating = 2). Regardless of mechanism, air-fluid level and hemoptysis correlated with death (p < 0.02) and all patients with hemoptysis required pulmonary intervention (p = 0.0001).

CONCLUSION

Penetrating TPPs demonstrate a unique pattern of concurrent lung injury and increased complication risk. Importantly, severe hemoptysis and air-fluid level may indicate risk of impending morbidity and mortality regardless of injury mechanism and should serve as an early warning sign for the trauma physician.

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.

Traumatic Pulmonary Pseudocysts in a Young Dog Following Non-penetrating Blunt Thoracic Trauma

Traumatic pulmonary pseudocysts following non-penetrating blunt thoracic trauma is a well-described phenomenon in the human literature, while in veterinary medicine, this disease process is rarely reported and poorly described in the current literature available. This case report describes a 1.5-year-old male castrated Labrador retriever with findings of pulmonary cysts following a road traffic accident. The goal of this report is to expound upon the pathophysiology, diagnosis, and treatment of this disease process in the veterinary field.

Traumatic pseudocyst due to blunt trauma: Case report

Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst.

Pulmonary pseudocyst secondary to blunt or penetrating chest trauma: clinical course and diagnostic issues

PURPOSE

Traumatic pulmonary pseudocysts (TPPs) are rare complications of chest trauma. The aim of this retrospective study was to report the clinical presentations, diagnosis, complications and treatment for a series of TPPs at a hospital in Turkey.

METHODS

The charts of 996 patients who were admitted for thoracic trauma between 1999 and 2012 were retrospectively reviewed. Fifty-two patients had TPPs, and the data collected for these individuals were sex, age, and type of trauma (blunt and/or penetrating). Univariate analysis of categorical data was performed using Pearson's Chi square test. Results for continuous variables were statistically compared using the Mann-Whitney U test.

RESULTS

The patients were 42 males and 10 females aged 12-72 years (mean age 33.1 years). Forty-one had blunt trauma and 11 had penetrating trauma. There was no significant difference between the proportion of blunt trauma patients who developed TPP (41/761, 5.3%) and the proportion of penetrating trauma patients who developed TPP (11/235, 4.6%) (p > 0.05). All 42 patients had pulmonary contusion. Only 10 patients (19.2%) had TPP identified on their chest X-ray, and thoracic computed tomography revealed TPP clearly in all these cases. Forty-two patients (80.7%) were diagnosed with TPP on day 1 post-trauma. The hospital stays ranged from 2 to 35 days for the patients with blunt-trauma, and from 4 to 15 days for those with penetrating trauma (means 8.8 and 8.0 days, respectively; p > 0.05). Only one patient required thoracotomy for a pseudocyst that did not resolve and became progressively enlarged. This TPP was resected at 6 months post-trauma. One patient died on day 9 post-trauma due to multiple organ failure. The other 40 pseudocysts resolved spontaneously within 1-5 months.

CONCLUSIONS

Traumatic pulmonary pseudocysts are pulmonary lesions that occur after either blunt or penetrating trauma and tend to be overlooked. Most of these lesions are self-limiting, benign lesion.

Posttraumatic pulmonary pseudocysts as a manifestation of child abuse

Posttraumatic pulmonary pseudocysts (PTPPCs) are air-, fluid-, or blood-filled spaces in the lung parenchyma. They are rare findings and are associated with substantial blunt force trauma to the chest. Cases in the literature have primarily reported PTPPCs as a result of motor vehicle accidents. There has not been a case of PTPPC reported in the child abuse literature. This case report describes a child with a PTPPC secondary to inflicted abusive injury.