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Traumatic pulmonary pseudocyst: an unusual cause of a cavitary pulmonary nodule

A previously healthy 34-year-old man presented to the emergency department 1 day after being involved in a motor vehicle accident. He complained of right-sided chest pain, cough, and hemoptysis. Chest CT showed a small cavitary nodule, containing an air-fluid level and surrounded by ground-glass opacities, in the right lower lobe (Figure 1A). A diagnosis of traumatic pulmonary pseudocyst (TPP) was made. The case was managed conservatively, and there were no complications. A follow-up CT scan acquired 12 days later showed that the cystic lesion had evolved to a homogeneous nodule (Figure 1B). Another CT scan acquired three months later showed a marked reduction in the volume of the lesion.

Figure 1
In A, an axial chest CT scan showing a small cavitary lesion, containing an air-fluid level and surrounded by ground-glass opacities, in the right lower lobe. A small pleural effusion is also visible. In B, a follow-up CT scan acquired 12 days later, showing that the cavitary lesion had evolved to a homogeneous nodule with hematic content, together with reabsorption of the ground-glass opacities and of the pleural effusion.

An uncommon lesion associated with traumatic chest injury, TPP occurs as a consequence of traumatic disruption of the lung parenchyma, with subsequent filling of the traumatic intraparenchymal defect with air, blood, or both. The condition is frequently associated with pulmonary contusions.11 Hazer S, Orhan Söylemez UP. Clinical features, diagnosis, and treatment of traumatic pulmonary pseudocysts. Ulus Travma Acil Cerrahi Derg. 2018;24(1):49-55. https://doi.org/10.5505/tjtes.2017.56023
https://doi.org/10.5505/tjtes.2017.56023...

2 Tsitouridis I, Tsinoglou K, Tsandiridis C, Papastergiou C, Bintoudi A. Traumatic pulmonary pseudocysts: CT findings. J Thorac Imaging. 2007;22(3):247-251. https://doi.org/10.1097/RTI.0b013e3180413e2a
https://doi.org/10.1097/RTI.0b013e318041...
-33 Phillips B, Shaw J, Turco L, McDonald D, Carey J, Balters M, et al. Traumatic pulmonary pseudocyst: An underreported entity. Injury. 2017;48(2):214-220. https://doi.org/10.1016/j.injury.2016.12.006
https://doi.org/10.1016/j.injury.2016.12...
Common symptoms include chest pain, dyspnea, cough, and hemoptysis, although some patients are asymptomatic. The most common finding on CT is a round or oval cystic structure, with or without an air-fluid level. The lesion is typically surrounded by ground-glass opacities or consolidations resulting from pulmonary contusion. The management of TPP is conservative, because the clinical course is usually benign.11 Hazer S, Orhan Söylemez UP. Clinical features, diagnosis, and treatment of traumatic pulmonary pseudocysts. Ulus Travma Acil Cerrahi Derg. 2018;24(1):49-55. https://doi.org/10.5505/tjtes.2017.56023
https://doi.org/10.5505/tjtes.2017.56023...

2 Tsitouridis I, Tsinoglou K, Tsandiridis C, Papastergiou C, Bintoudi A. Traumatic pulmonary pseudocysts: CT findings. J Thorac Imaging. 2007;22(3):247-251. https://doi.org/10.1097/RTI.0b013e3180413e2a
https://doi.org/10.1097/RTI.0b013e318041...
-33 Phillips B, Shaw J, Turco L, McDonald D, Carey J, Balters M, et al. Traumatic pulmonary pseudocyst: An underreported entity. Injury. 2017;48(2):214-220. https://doi.org/10.1016/j.injury.2016.12.006
https://doi.org/10.1016/j.injury.2016.12...

REFERENCES

  • 1
    Hazer S, Orhan Söylemez UP. Clinical features, diagnosis, and treatment of traumatic pulmonary pseudocysts. Ulus Travma Acil Cerrahi Derg. 2018;24(1):49-55. https://doi.org/10.5505/tjtes.2017.56023
    » https://doi.org/10.5505/tjtes.2017.56023
  • 2
    Tsitouridis I, Tsinoglou K, Tsandiridis C, Papastergiou C, Bintoudi A. Traumatic pulmonary pseudocysts: CT findings. J Thorac Imaging. 2007;22(3):247-251. https://doi.org/10.1097/RTI.0b013e3180413e2a
    » https://doi.org/10.1097/RTI.0b013e3180413e2a
  • 3
    Phillips B, Shaw J, Turco L, McDonald D, Carey J, Balters M, et al. Traumatic pulmonary pseudocyst: An underreported entity. Injury. 2017;48(2):214-220. https://doi.org/10.1016/j.injury.2016.12.006
    » https://doi.org/10.1016/j.injury.2016.12.006

Publication Dates

  • Publication in this collection
    22 Apr 2020
  • Date of issue
    2020
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