AB 68. Post-traymatic lung pseudocysts: two case
reports in ICU patients
Background: The traumatic lung pseudocyst is a rare complication
of closed thoracic injury in which increased pressure on pulmonary
parenchyma causes laceration (shearing) of the parenchyma without
rupture of the pleura. We present two cases with traumatic lung
pseudocyst who were admitted in our ICU. Brief review of this entity.
Patients and methods: Case 1. A 19 years old man was admitted in the
ICU after a motorcycle accident. Cerebral computed tomography (CT)
showed left epidural hematoma. Chest CT scanning revealed two well
defined densities in the right upper lung lobe with presence of air bubbles
within them and ground glass appearance of the pulmonary parenchyma.
The patient was operated by neurosurgeons in order to remove the
epidural hematoma. Four days after admission chest CT was repeated and
showed two cavitary lesions in the upper lobe with tree in bud sign in the
rear section of the right lower lobe. Two samples of bronchial secretions
were collected: Ziehl Nilsen staining, gene probe test for M. tuberculosis
and culture for mycobacterium tuberculosis were negative. Mantoux
test was negative.These findings were compatible with the diagnosis of traumatic pseudocyst. The patient showed gradual clinical improvement.
Repeated chest CT scan after 6 months was within normal limits. Case 2.
A 41 years old man was involved in a car-bicycle accident (he was riding
the bicycle). The patient was admitted in the ICU with respiratory failure
and flail chest. Chest CT scanning revealed subcutaneous emphysema,
multiple bilateral rib fractures, fracture of the right clavicle, fracture of the
sternum, right pneumothorax, bilateral hemothorax, and contusions of the
right lung. The next day the patient was intubated because of progressive
respiratory failure. Two days after admission chest CT was repeated and
showed formation of lung pseudocyst, remaining pneumothorax and
hemothorax. The clinical course was complicated with febrile respiratory
infection and haemodynamic instability. He was treated with broad
spectrum antibiotics. The patient was gradually stabilised and finally was
weaned from mechanical ventilation (with a tracheostomy). 22 days after
the accident the chest CT revealed resolution of the pseudocysts, and
bilateral pleural effusion.
Conclusions: The traumatic lung pseudocyst is a rare complication
of blunt thoracic trauma. The clinical course of traumatic lung
pseudocyst is usually benign, requiring only supportive therapy, unless
complications such as pneumothorax or infection of the cavitary lesion
arise. These lesions are more common in children and young adults.
Cite this abstract as: Voutsas V, Giakamozis A, Lazaridis T, Bitzani M. Posttraymatic
lung pseudocysts: two case reports in ICU patients. J Thorac Dis
2012;4(S1):AB68. DOI: 10.3978/j.issn.2072-1439.2012.s068