Pseudocyst of the lung due to traumatic nonpenetrating lung injury

ByMarilyn

Pearl,

M.D.,

Mona

Milstein, New York,

M.D.,

and George

D. Rook,

M.D.

N. Y.

Ser~uu\ injuries a$soclatrd with nonpcnetrating trauma to the thorax have been repurted freyucntly in the literature.’ Pulmunury contl,sion after minor dcgrccv of injury is common ,md resultr in characteristic radiugraphiL, patterns. ‘2 Radiolucenr cystic areas seen within an arca 01 pulmonary contusion may present :I problem in diagnuG<. A 3-yr-old girl fell from a t‘ourth story window without loss of cunxiousness. Physical c\aminalion wa\ normal except for contuacd arear over the right arm. the abdomen and behind the right rate 42/min, and blood pre%surc 96/6tI. Laborator) car. ‘The pulse rate was I ZO/min. respiratory data ~vas nor*nal. Twenty minutes later respiration\ became labored and coarse raleh and ahec~ex were heard bilaterally. Chest rocntgenograms (Fig. I A) showed a pulmonary contusion pattern with unusual air shadows best seen in the oblique projection (Fig. 1B). She had a fever of 103’1. the nr\t day. A barium swallow ruled out rupture of the es;ophagur.The child was treated \\ith ~~\ysc,‘. high humidity. potassium Iodide . and postural draina!c. I arty-eight hours later she WI\ afebrile and b! the \ixth hospital day \he \\a\ clinically v,cll T\VO week\ kiter the chest rocntgrn~>gram M:I\ normal. The pathoeencsis of pulmonary cuntusiun injury is the prcscnc’c of high positive-I~rc~~urt \\a\~\ that compress the chest and abd~jrnen. not only by the markedly incrcusrd pre<\urc t-rut 1)~ the absent. fvrcc ot the wavy traveling at trcmcndous qpccd.4’” Rib injuries arc frcqucntl> Patients. who at first arc arymptomatic. can. \\ithin a fc~ hour\ develop hcmoptyk. dyspnca. dccrcascd breath sounds. wheezes. and rules. Translent temperature elevation 24 hr later I\ trften ~ noted. Areas of Increased density \een on chest radiographs do not conform to seglncnth or Iobc\ ot‘ the Lung. The process clears rapidly. r 6 Kounded radiopaqur dcnsitics persibting as I~)ng a\ I yr represent pulmonary hematoma\. 7 ~~cll-circum\cribcd radioluccncies resembling lung cysts. ahucess. or pneumatocck

Fig. l.(A) Note

(6) Oblique

Journal

Initial

multiple

c‘an appear

within

chest roentgenogram

air-filled

cystic structures

the first 24 hr. These result from obstruction

with confluent

density

caused

b!

in right lower and mid lung fielcis.

to the right of the midline

and in the right perihilar

area.

projection.

of Pedmtr~~

Surgery.

Vol 8 No 6 (December). 1973

967

CASE

968

REPORTS

intrabronchial or peribronchial hemorrhage. Superimposed pneumonia is frequently associated with pulmonary contusion since a hemorrhagic, necrotic parenchyma serves as a culture medium for bacteria.s Only symptomatic therapy is required with appropriate antibiotics if indicated. Both clinical and radiographic findings usually return to normal within l-2 wk. REFERENCES 1. Hughes RR: Thoracic trauma: Collective review. Am Thorac Surg 1:778-804, 1965 2. Williams JR, Stembridge VA: Pulmonary contusion secondary to non-penetrating chest trauma. Am J Roentgen01 Radium Ther Nucl Med. 91:284-296. 1964 3. Stevens E. Templeton AN: Traumatic nonpenetrating lung contusion. Radiology 85:247252, 1965 4. Zuckerman S: Experimental studies of blast injury of the lung, Lancet 2:219-224, 1940

5. Shepard GH, Ferguson J, Foster JH: Pulmonary contusion, Ann Thorac Surg 7:l lo119,1969 6. Scaly WC: Contusions of the lung from non-penetrating injuries of the thorax., Arch Surg 59:882-887. 1949 7. Williams JR: Vanishing lung tumor-Pulmonary hematoma, Am J Roentgen01 Radium Ther Nucl Med 81:296-302, 1959 8. Blair E, Topuzlu C, Davis JH: Delayed or missed diagnosis of blunt chest trauma, J Trauma 11:129-145, 1971