G. Hahn (Dresden)  

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17 Years  

Male  

Thorax-Other and unknown  

physical  

A 17 4/12 year-old asthenic adolescent fell down on stone steps, falling 8 steps and landed on his back. Because of strong back pain with loss of movement, he was admitted to a surgical department. X-Ray images of the skull, hand and thorax showed no fractures. After 2 days, he was discharged in better condition. On the evening after being discharged, the patient coughed up a mass of mixed dark and light colored blood (the size of a quarter) for the first time, as well as the following 4 days (up to 5 times a day). Renewed admittance 4 days after the accident, thoracic x-ray followed, which showed a cystic lesion retrocardial. Otherwise unremarkable bodily findings, particularly no hematomas on the thorax and no remarkable lung auscultation.

Other findings: Blood values, Quick, PTT, CRP, alpha-1-Antitrypsin, Abdomensonography: normal range. Lung function: Slight obstruction, borderline VC (83.5% d.S.), Bronchospasmolysis test was negative.  

Traumatic pneumatoceles, which occur after blunt thoracic trauma, can be localized in the lung's parenchyma or in the mediastinum. They can be associated with other pulmonary manifestations such as contusional areas or intraparenchymatic hematomas. They can develop within minutes or within hours. Pneumatoceles are thin-walled and can take on a very large size. They are either single or multiple, and can be round or oval. Some show blood levels. Most disappear in 2-3 weeks. Seldom, one sees complications with rupture or infection with pneumatoceles.  

<- view X-Ray 1

X-Ray 1: Thorax p.a. (4th day after trauma): Retrocardial to the left in cranio-caudal direction, one sees a longitudinal paravertebral cystic structure with fluid-levels.







<- view X-Ray 2

X-Ray 2: Thorax lateral - (4th day after trauma): the longitudinal paravertebral cystic structure with fluid-levels is not seen in the lateral view.








<- view X-Ray 3

X-Ray 3: Esophageal fluoroscopy with (on the same day) contrast media taken p.o. Unnoticeable esophageal image. No proof of a relationship between the esophagus and the cystic structure.












<- view CT 1

CT 1: (the same day): Dorsal paravertebral cystic mass (left) of about 4 x 2.5 cm with fluid-levels. Neighboring lung parenchyma: contusion with hemorrhage.




<- view CT 2

CT 2: (7 months later): Unremarkable lung structures, the other previous changes were no longer seen.

 

Expert's opinion  

Connatal bronchogenic/enterogenic cyst
Diaphragmal hernia  

The hemoptyses stopped after the 5th day after the accident. In the following months, the patient was clinically normal.  

The predominantly trivial patient history (no rib or vertebral fracture, fast clinical improvement) and the outer unremarkable findings of the boy after the fall (no hematomas), led us to believe that the accident was not the only cause of the large cystic mass, and a cystic lung malformation with lung contusional areas in the region was more likely. This case shows, however, that even in a "trivial" thoracic trauma, remarkable intrathoracic lung injuries with pneumatoceles and contusional areas can occur, which are not able to be differentiated from a cystic lung malformation with surrounding lung contusion in x-ray and in thoracic CT.  

N/A  

1. Medline:
Leonhard E.Swischuk
Emergency Imaging of the Acutely Ill or Injured Child  

Lung, malformation, pneumatocele, accident, posttraumatic pneumatocele, ligamentum pulmonale inferior, inferior pulmonary ligament, child, childhood, pediatric radiology  

G Hahn. Posttraumatic pneumatocele in the ligamentum pulmonale inferior. PedRad [serial online] vol 1, no. 11.
URL: www.PedRad.info/?search=20011127230323