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Usman S, Haseeb S, Khan MJ, Weber A. A 65-Year-Old Man With Concerns of Hemoptysis After Recent Motor Vehicle Accident and Blunt Trauma to Chest. Chest 2023; 164:e173-e176. [PMID: 38070965 DOI: 10.1016/j.chest.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 12/18/2023] Open
Abstract
CASE PRESENTATION A 65-year-old man with a medical history of anxiety and depression came to the ED with concerns of coughing blood-tinged phlegm for the past 3 days. Four days before the presentation, the patient had a motor vehicle accident as a restrained driver with airbag deployment. The patient struck his chest against the steering wheel. He was evaluated at a level 1 trauma center and underwent a whole-body scan, including a CT scan of the chest, which showed no acute abnormalities. Apart from mild-to-moderate bruising and tenderness on the right side of his face, nose, and anterior chest, the patient was stable and was discharged the next day. After returning home, the patient started coughing blood-tinged phlegm, which became progressively bloodier for the next 3 days, achieving individual posttussive volumes of 1 T of frank blood. In the ED, the patient denied any similar symptoms in the past. He denied any recent or distant known history of malignancy, infections, or travel outside the United States. He lives by himself and previously worked various jobs. He endorsed active tobacco use and smoking 3 to 6 cigarettes per day for the past 20 years with 5 pack-year history. Patient reported consuming one to two alcohol drinks per month.
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Affiliation(s)
| | - Shahan Haseeb
- Mather Hospital, Northwell Health, Port Jefferson, NY
| | | | - Andrew Weber
- Division of Intensive Care Medicine and Pulmonary Medicine, Mather Hospital Northwell Health, Port Jefferson, NY; Donald and Barbara School of Medicine, Hofstra/Northwell, Hempstead, NY
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2
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Villanueva Campos A, Oikonomou A, Jiménez-Juan L, Gorospe Sarasúa L, Villanueva Marcos A. Severe non-cardiovascular thoracic trauma: diagnostic clues on computed tomography. RADIOLOGIA 2023; 65:258-268. [PMID: 37268368 DOI: 10.1016/j.rxeng.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/16/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVE About 60% of multiple trauma patients have thoracic trauma, and thoracic trauma results in the death of 10% of these patients. Computed tomography (CT) is the most sensitive and specific imaging modality for the diagnosis of acute disease, and it helps in the management and prognostic evaluation of patients with high-impact trauma. This paper aims to show the practical points that are key for diagnosing severe non-cardiovascular thoracic trauma by CT. CONCLUSION Knowing the key features of severe acute thoracic trauma on CT is crucial to avoid diagnostic errors. Radiologists play a fundamental role in the accurate early diagnosis of severe non-cardiovascular thoracic trauma, because the patient's management and outcome will depend largely on the imaging findings.
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Affiliation(s)
- A Villanueva Campos
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - A Oikonomou
- Departamento de Radiología, Sunnybrook Health Sciences Centre, Universidad de Toronto, Toronto, Canada
| | - L Jiménez-Juan
- Departamento de Radiología, St. Micheal's Hospital, Universidad de Toronto, Toronto, Canada
| | - L Gorospe Sarasúa
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Villanueva Marcos
- Departamento de Radiología, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom
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3
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Traumatismo torácico grave no cardiovascular: Claves diagnósticas en tomografía computarizada. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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4
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Neudecker J, Schulz-Drost S, Walles T. [Treatment of Persistent Parenchymal Lung Injuries in Thoracic Trauma: Lung Laceration, Pleural Fistula and Pneumothorax]. Zentralbl Chir 2023; 148:93-104. [PMID: 36822185 DOI: 10.1055/a-1898-7611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Thoracic trauma is a frequent injury pattern with high patient morbidity and mortality. Preclinical and clinical emergency treatment is consented in a national S3-guideline. Following emergency therapy one third of patients may develop lung lacerations, pleural fistulation and persisting pneumothorax. An interdisciplinary working group of the German Society for Thoracic Surgery and the German Society for Traumatology reviewed the published medical literature on treatment of those injuries and assessed the existing evidence according to consensus recommendations. An inconsistent classification of those subsequent lung injuries was found. Evidence for diagnostic and therapeutic recommendations is small.
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Affiliation(s)
- Jens Neudecker
- Chirurgische Klinik - Zentrum für Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Stefan Schulz-Drost
- Klinik für Unfallchirurgie und Traumatologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Thorsten Walles
- Klinik für Herz- und Thoraxchirurgie, Abteilung Thoraxchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg, Deutschland
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5
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Rochester A, Gonzalez‐Gasch E, Casamian‐Sorrosal D, Erles K. Suspected spontaneous idiopathic pulmonary pneumo‐haematocele in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Domingo Casamian‐Sorrosal
- Veterinary and Experimental Sciences Faculty Catholic University of Valencia Saint Vincent Martyr Valencia Spain
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6
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Neumatoceles tras accidente de alto impacto. OPEN RESPIRATORY ARCHIVES 2021. [PMID: 37496766 PMCID: PMC10369635 DOI: 10.1016/j.opresp.2021.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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7
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Son SA, Lee SC, Cho JY. Successful management of traumatic giant pulmonary hematoma in poly-trauma patient. Trauma Case Rep 2021; 32:100433. [PMID: 33681441 PMCID: PMC7930350 DOI: 10.1016/j.tcr.2021.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 10/30/2022] Open
Abstract
Traumatic pulmonary giant hematoma, resulting from blunt trauma, is a relatively rare event. Here, we report the rare case of a patient with a giant traumatic pulmonary hematoma that was associated with blunt trauma. A 50-year-old man was admitted to our medical center after a fall from a height of 5 m. He was diagnosed with pulmonary contusion, and tests showed a huge pulmonary hematoma of approximately 8.2 × 5.3 × 13.2 cm in the left lung field along with other significant injuries. Treatment comprised of aggressive coagulation management, broad-spectrum antibiotics, and pulmonary hygiene. The patient's symptoms gradually improved and magnetic resonance scan revealed that he did not develop an abscess formation. No complications were seen at the 6 months follow-up visit. If the above mentioned measures would have failed to control the bleeding or secondary infection, then emergency surgery would have been warranted. Awareness of this kind of injury and efforts to reduce infection are important to guide the giant traumatic pulmonary hematoma to the benign course.
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Affiliation(s)
- Shin-Ah Son
- Trauma Center, Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Cjeol Lee
- Trauma Center, Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Joon Yong Cho
- Trauma Center, Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
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8
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Solitary Pulmonary Hematoma Radiographically Indistinguishable from Mediastinal Tumor. Case Rep Surg 2020; 2020:8821137. [PMID: 33425423 PMCID: PMC7775178 DOI: 10.1155/2020/8821137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Solitary pulmonary hematoma is a rare consequence of blunt chest trauma. Moreover, there has been no reported case of solitary pulmonary hematoma radiographically diagnosed as a posterior mediastinal tumor. We present the case of a 63-year-old man who was referred for an oval-shaped opacity at the left paraspinal area on a chest X-ray. Chest computed tomography showed a well-circumscribed posterior mediastinal tumor on the left paraspinal lesion with extrapleural sign and callus formation on the left ribs posteriorly (7th to 11th ribs). The tumor was thoracoscopically confirmed to be a subpleural pulmonary tumor of the left lower lobe, and wedge resection was performed. Histological examination confirmed the diagnosis of pulmonary hematoma. On reviewing the callus formation of the ribs, which was suggestive of rib fractures, the pulmonary hematoma was determined to be traumatic in origin. The postoperative course was uneventful. We reviewed a rare case of pathologically proven traumatic solitary pulmonary hematoma. The rarity of this case is enhanced because the hematoma initially appeared to be a posterior mediastinal tumor.
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9
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Beattie G, Cohan CM, Tang A, Yasumoto E, Victorino GP. Differences in clinical characteristics and outcomes for blunt versus penetrating traumatic pulmonary pseudocysts. Am J Emerg Med 2020; 45:433-438. [PMID: 33036865 DOI: 10.1016/j.ajem.2020.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/29/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Genna Beattie
- Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, United States of America.
| | - Caitlin M Cohan
- Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, United States of America
| | - Annie Tang
- Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, United States of America
| | - Eric Yasumoto
- Department of Radiology, Highland Hospital, Oakland, CA, United States of America
| | - Gregory P Victorino
- Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, United States of America
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10
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Canan A, Batra K, Saboo SS, Landay M, Kandathil A. Radiological approach to cavitary lung lesions. Postgrad Med J 2020; 97:521-531. [PMID: 32934178 DOI: 10.1136/postgradmedj-2020-138694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 11/03/2022]
Abstract
Cavitary lesions in the lung are not an uncommon imaging encounter and carry a broad differential diagnosis that includes a wide range of pathological conditions from cancers, infections/inflammatory processes to traumatic and congenital lung abnormalities. In this review article, we describe a comprehensive approach for evaluation of cavitary lung lesions and discuss the differential diagnosis in the light of radiological findings.
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Affiliation(s)
| | - Kiran Batra
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
| | - Sachin S Saboo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78229, USA
| | - Michael Landay
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
| | - Asha Kandathil
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
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11
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Marchiori E, Hochhegger B, Zanetti G. Traumatic pulmonary pseudocyst: an unusual cause of a cavitary pulmonary nodule. ACTA ACUST UNITED AC 2020; 46:e20190397. [PMID: 32321036 PMCID: PMC7572291 DOI: 10.36416/1806-3756/e20190397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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12
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Sugimura A, Takahashi T, Sekihara K, Nagasaka S. Case of Rapid Formation of Intraoperative Pulmonary Pneumatocele After Lobectomy. Ann Thorac Surg 2020; 110:e331-e332. [PMID: 32302662 DOI: 10.1016/j.athoracsur.2020.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/27/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
Pulmonary pneumatocele that forms immediately after pulmonary resection is extremely rare. This report describes a case of pneumatocele that formed rapidly in the left lower lobe immediately after left upper lobectomy in a patient with lung cancer and emphysema. Massive and persistent air leakage through a chest tube was noted immediately after chest closure. Therefore, the chest was reopened, and the cyst wall was incised. The air leakage point was cauterized and covered with a polyglycolic acid sheet and fibrin glue. Herein, we report a rare case of newly developed pneumatocele immediately after lobectomy.
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Affiliation(s)
- Aya Sugimura
- Department of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tsuyoshi Takahashi
- Department of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Keigo Sekihara
- Department of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Nagasaka
- Department of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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13
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Trauma-Associated Pulmonary Laceration in Dogs-A Cross Sectional Study of 364 Dogs. Vet Sci 2020; 7:vetsci7020041. [PMID: 32290621 PMCID: PMC7356257 DOI: 10.3390/vetsci7020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 12/03/2022] Open
Abstract
In this study, we describe the computed tomography (CT) features of pulmonary laceration in a study population, which included 364 client-owned dogs that underwent CT examination for thoracic trauma, and compared the characteristics and outcomes of dogs with and without CT evidence of pulmonary laceration. Lung laceration occurred in 46/364 dogs with thoracic trauma (prevalence 12.6%). Dogs with lung laceration were significantly younger than dogs in the control group (median 42 months (interquartile range (IQR) 52.3) and 62 months (IQR 86.1), respectively; p = 0.02). Dogs with lung laceration were significantly heavier than dogs without laceration (median 20.8 kg (IQR 23.3) and median 8.7 kg (IQR 12.4 kg), respectively p < 0.0001). When comparing groups of dogs with thoracic trauma with and without lung laceration, the frequency of high-energy motor vehicle accident trauma was more elevated in dogs with lung laceration than in the control group. No significant differences were observed between groups regarding tge frequency and length of hospitalization and 30-day mortality. Similar to the human classification scheme, four CT patterns are described in dogs in this study: Type 1, large pulmonary laceration located deeply in the pulmonary parenchyma or around an interlobar fissure; Type 2, laceration occurring in the paraspinal lung parenchyma, not associated with vertebral fracture; Type 3, subpleural lung laceration intimately associated with an adjacent rib or vertebral fracture; Type 4, subpleural lesions not associated with rib fractures. Complications were seen in 2/46 dogs and included lung abscess and collapse.
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14
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Edwards JD, Anciano CJ, Bard MR. Traumatic Pneumatocele. Am Surg 2019. [DOI: 10.1177/000313481908500913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacob D. Edwards
- Department of Surgery The Brody School of Medicine East Carolina University Greenville, North Carolina
| | - Carlos J. Anciano
- Division of Thoracic and Foregut Surgery Department of Surgery The Brody School of Medicine East Carolina University Greenville, North Carolina
| | - Michael R. Bard
- Division of Trauma and Surgical Critical Care Department of Surgery The Brody School of Medicine East Carolina University Greenville, North Carolina The Center of Excellence in Trauma and Surgical Critical Care Vidant Medical Center Greenville, North Carolina
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15
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Mulholland N, Keir I. Traumatic Pulmonary Pseudocysts in a Young Dog Following Non-penetrating Blunt Thoracic Trauma. Front Vet Sci 2019; 6:237. [PMID: 31380401 PMCID: PMC6646529 DOI: 10.3389/fvets.2019.00237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 07/02/2019] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Natosha Mulholland
- Department of Emergency and Critical Care, Allegheny Veterinary Emergency Trauma & Specialty, Monroeville, PA, United States
| | - Iain Keir
- Department of Emergency and Critical Care, Allegheny Veterinary Emergency Trauma & Specialty, Monroeville, PA, United States
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16
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Bedel C, Özkaya M. Diagnosis and prognosis of traumatic pulmonary pseudocysts. Indian J Thorac Cardiovasc Surg 2019; 35:186-189. [PMID: 33061003 DOI: 10.1007/s12055-018-0762-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose 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. Methods A retrospective study was undertaken in 30 cases treated in Antalya Training and Research Hospital, Turkey, from January 2014 to December 2017. Results The 30 patients with TPP were 28 males (93.3%) and 2 females (6.7%) aged 14-64 years (mean age 31.9 years). Most of them are located in the right lower lobe (50%). The mean size of TPP was 2.07 cm. The overall resolution time for TPP was found to range from 8 to 124 days with a mean of 45.1 ± 32.9 days. Conclusions 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.
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Affiliation(s)
- Cihan Bedel
- Health Science University Antalya Training and Research Hospital Emergency Medicine Department, Antalya, Turkey
| | - Muharrem Özkaya
- Department of Thorasic Surgery, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
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17
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Traumatic Pulmonary Pseudocyst Mimicking a Congenital Cystic Lung Disease. Case Rep Pulmonol 2018; 2018:7269694. [PMID: 30112242 PMCID: PMC6077363 DOI: 10.1155/2018/7269694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022] Open
Abstract
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.
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18
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Armstrong LB, Mooney DP. Pneumatoceles in pediatric blunt trauma: Common and benign. J Pediatr Surg 2018; 53:1310-1312. [PMID: 28917584 DOI: 10.1016/j.jpedsurg.2017.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/29/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Traumatic pneumatoceles are reported to be rare in children and to have an uncertain clinical significance. We report a single institution series of traumatic pneumatoceles to better define their frequency and clinical significance. METHODS After obtaining approval from the IRB, data were extracted from the trauma registry of a level 1 pediatric trauma center on children diagnosed with a pulmonary contusion (International Classification of Diseases-9th edition diagnosis codes: 861.21 to 861.31) who presented between June, 2006 and September, 2016. Patient demographics, mechanism of injury, injury severity score, diagnosis and procedure codes, length of hospital stay, outcome, imaging techniques and findings with attention to the identification of a pneumatocele, were examined. RESULTS Of the 10,229 trauma admission, 204 children were identified as having a pulmonary contusion, 25 of whom (12.3%) were diagnosed with a pneumatocele. Their mean age was 13years (3-17). Seventy-six percent (19) were male. The most common mechanism of injury was a motor vehicle collision (10), followed by falls (6), and sports (5). Sixteen children (64%) suffered a long bone fracture, 12 (48%) an abdominal solid organ injury and 3 (12%) a traumatic brain injury. The mean Injury Severity Score was 17 (9-34). Twenty-three patients presented as transfers. There were no fatalities. The pneumatocele was identified on chest computerized tomography (CT) alone in 15 (60%), on chest CT and chest radiograph (CXR) in 3 (12%), the upper portions of an abdominal CT in 6 (24%) and on CXR alone in 1 (4%). Seven patients were found to have a solitary pneumatocele and 18 patients had 2 or more. The largest pneumatocele was 3.7cm in diameter. Ten children (40%) were admitted to the intensive care unit, 3 of whom required intubation. One patient (4%) had a respiratory complication: pneumonia. Three patients underwent chest tube placement for: pneumothorax, hemothorax and hemopneumothorax. No child underwent intervention specific to the pneumatocele. Seventeen (68%) patients were seen in follow-up in Trauma Clinic and the remainder by another practitioner ranging from 1week to 6months after injury. One child (4%) underwent a follow-up chest CT to rule out a congenital pulmonary malformation 6months after injury and this demonstrated complete resolution of the pneumatocele. CONCLUSION The incidence of traumatic pneumatoceles among children with a pulmonary contusion was 12.3% in this series, but is probably higher given that only 24% were visible on radiographs and a small minority of children with pulmonary contusions underwent chest CT. Pneumatoceles are common in children with pulmonary contusions, but are usually small. The majority do not appear to be clinically significant nor require follow-up imaging. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lindsey B Armstrong
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA.
| | - David P Mooney
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA
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19
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Barge P, Fernández‐Del Palacio MJ, Santarelli G, Soler M, Agut A. Traumatic pulmonary pseudocysts associated to pneumothorax and rib fractures in a dog. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Pablo Barge
- Veterinary Teaching HospitalUniversity of MurciaMurciaSpain
| | | | | | - Marta Soler
- Veterinary Teaching HospitalUniversity of MurciaMurciaSpain
- Department of Medicine and SurgeryUniversity of MurciaMurciaSpain
| | - Amalia Agut
- Veterinary Teaching HospitalUniversity of MurciaMurciaSpain
- Department of Medicine and SurgeryUniversity of MurciaMurciaSpain
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20
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Traumatic pulmonary pseudocysts mimicking a congenital malformation of the lung. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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