Traumatic Lung Cyst In An Adult Patient Following Blunt Chest Trauma
CASE REPORT
Syed Muzzammil Wasti , Beena Zia, Sibtain Raza, S. Shafqat-ul-Islam, Haji Haroon
CASE REPORT
A 22-year-old young adult with no significant medical history
presented with blunt chest trauma following a road traffic
accident. He developed left-sided chest pain and fever. On
physical examination, the patient had a pulse rate of 80
beats/min, blood pressure of 120/80 mmHg and a respiratory
rate of 25 breaths/min. Cardiovascular, abdominal and
neurological examination did not reveal any abnormality.
IMAGING FINDINGS
Initial chest x ray showed pneumohemothorax on the left side.
No rib fracture seen. Few cavities were identified. His
subsequent chest X-ray revealed homogenous density of the
previously noted cavities with complete resolution
pneumothorax without any treatment. Further follow up X- rays
showed complete resolution of the rounded densities. His initial
Ultrasound showed small rounded anechoic area just above
the left hemidiaphragm with minimal pleural effusion. CT scan
done after the X ray and ultrasound which showed rounded
nodular lesions of HU 70, which means that, these nodular
densities are hemorrhagic.
DISCUSSION
Blunt chest traumas are more common than penetrating
traumas and generally result from car accidents or falls.1Lung
laceration due to trauma may result in pneumothorax,
haemothorax, contusion, traumatic pseudo cyst and massive
haemoptysis. Closed chest trauma may result in
development of one or more cystic spaces within the lung that
may remain air filled or may partly fill.2 The cyst may be single
or multiple, unilocular or multilocular ranging from 2-14 cm,
located subpleurally and usually appears 12-24 hours after
injury.
The cyst may contain air or blood derived from the torn alveolar
capillaries. The cyst wall is thin and is made up of fibrous
tissue and surrounding compressed alveolar tissue. Rarely,
there may be colonization of a post-traumatic lung cyst by an
asymptomatic aspergilloma.4
Karachi X- Rays & CT Scan / Ultrasound Centre
a) X Ray At the time of
of presentation shows mild left
hydropneumothorax and
atelectasis
c) CT Scan revealed nodular opacities
in both lungs having HU of 70
the suggesting hemmorhagic nature
e) Final x-ray chest. All
previously noted nodules
were completely resolved
b) Follow Up x-ray showed bilateral
multiple cavity lesions
d) Previously noted thin walled cavities
became denser with resolution of few
nodules
Three mechanisms have been suggested to explain their
development.5 Sudden compression of an area of the lung closes
off a segment of peripheral bronchial tree and creates within it a
bursting, explosive, pressure that is expended in the rupture of
successive alveolar walls within the lobules supplied by the
occluded bronchus Compression of the elastic chest wall while the
glottis is closed may result in rupture of the small bronchi and
pulmonary parenchymal disruption with cavitations because air
from the compressed part of the lung cannot escape quickly
enough A concussion wave produced by the blow to the chest
generates shearing stress that tears the lung parenchyma and
causes traumatic cavities. Traumatic cysts are more frequent
among young adults due to the greater flexibility of the chest,
which transmits kinetic energy more efficiently to the subjacent
pulmonary parenchyma.6
The differential diagnosis includes post infectious pneumatocele,
tuberculous or mycotic cavity, pulmonary abscess, cavitating
carcinoma, cavitating or infected haematoma, and ruptured
diaphragm with protrusion of bowel into the chest space. These are
differentiated by the history of trauma, absence of proceeding
respiratory symptoms, and the absence of crackles and
borborygmi upon chest auscultation.7 Traumatic pulmonary cysts
may be identified on plain radiographs: an air fluid level may be
visible, surrounded by consolidated lung due to pulmonary
contusion; however, a CT scan is much better for detecting this
lesion.8 Clinical course of traumatic lung cysts is usually
uncomplicated. Spontaneous regression occurs in 2-6 weeks
although the cyst may occasionally persist for up to 4 months.
Surgical resection is not necessary provided there is definite
evidence of decreasing size of the lesion by 6 weeks following
injury in adults and by 3 months in children. Surgery is indicated if
there is an infective complication unresponsive to antibiotic
treatment or if other cavitatory lesions of the lung are to be
excluded.2
REFERENCES
1. Shorr RM. Blunt thoracic trauma: analysis of 515 patients. Ann Surg 1987; 206 (2):200-5.
2. P Sundaram, K Agrawal, D Balakrishnan, R T Kamble, J M Joshi.A lung cyst following blunt chest
trauma.Postgrad Med J 2000;76:45-47
3. Kato R. Traumatic pulmonary pseudocyst: report of twelve cases. J Thorac Cardiovasc Surg 1989; 97
(2): 309-12.
4. Torre W, Dominguez L. The colonisation of post traumatic lung cyst by an asymptomatic
aspergilloma.
Ann Intern Med 1997; 14:539
5. Shamji FM, Sachs HJ, Perkins DG. Cystic disease of the lungs. Surg Clin N Am 1988; 68:581-620
6. Moore FA. Post-traumatic pulmonary pseudocyst in the adult: pathophysiology, recognition, and
selective management. J Trauma 1989; 29 (10): 1380-5.
7. David R. Ulstad, John C. Bjelland, Stuart F.Quan.Bilateral Paramediastinal post-traumatic lung cysts-
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8. A. De, K. Birch, J. Nolan, C.J. Peden. Traumatic pulmonary cyst. Am J Roentgenol 1966; 97: 186. 11.