A lung cyst following blunt chest trauma

Abstract

A young man with bronchial asthma and an abnormal chest X-ray A S Kashyap, S Kashyap A 29-year-old man with bronchial asthma of 5 years duration was using inhaled salbutamol. In view of recurrent exacerbations, he had been put on oral prednisolone 20 mg/day for the last year. He did not smoke tobacco or drink alcohol. He had no other complaints. Clinically he had moon facies, buValo hump, centripetal obesity, purple striae on flanks and proximal myopathy. His blood pressure was 140/100 mmHg. Chest examination revealed polyphonic rhonchi in all areas. The rest of the general and physical examination was normal. Investigations revealed a normal haemogram, urinalysis, fasting and post-prandial plasma glucose, serum sodium, potassium, calcium and phosphate levels. Pulmonary function test showed an obstructive pattern. His chest X-ray (postero-anterior) is shown in figure 1. Chest X-ray a year earlier had been normal. Serum cortisol levels were 130 nmol/l at 08.00 h (normal 140-690 nmol/l) and 76 nmol/l at 16.00 h (80-330 nmol/l). Urine 24-hour calcium was 3.2 mmol (< 3.8 mmol). Questions1 What are the abnormalities seen on the chest X-ray? 2 What is the pathophysiology of these abnormalities ?Figure Chest X-ray (postero-anterior)Postgrad Med J 2000;76:41-60

Diagnostic dilemmas, course, management and prognosis of traumatic lung cysts in children

“…They present with pain, dyspnea and hemoptysis. 1,5 The cysts may be obvious in chest radiographs done immediately after the trauma as seen in the second patient or, the chest radiograph may show only pulmonary contusion as seen in the first patient. 1 CT scan is considered the definitive diagnostic tools to diagnose TLCs.…”

“…10 Hemoptysis as a symptom should point towards the diagnosis of traumatic lung cysts. 1,5 On helical CT scans, demonstration of waist like constriction of herniated bowel and further digital reconstructions which detect discontinuity of the diaphragm should settle the diagnosis. 11 However, if these signs are not obvious on CT examination, as in the first case, a laparoscopy may be both diagnostic and therapeutic.…”

“…12 A loculated hemo-pneumothorax can give rise as a very similar picture to that of a traumatic lung cyst, when the laceration of the lung is accompanied by hemorrhage into the lacerated area. 5 Other cysts e.g., those of congenital origin or those following necrotic pneumonias should also be borne in mind as differential diagnoses. A majority of these cysts resolve spontaneously as was also noted in our patients.…”

“…2,3,4 Lung cysts seen in the setting of trauma can also be confused with a cavitating hematoma and an encysted pneumothorax. 5 The management of each of the above lesions is distinct, emphasizing the need for diagnostic accuracy. The radiologic picture of the lung with post traumatic cysts may mimic a post traumatic rupture of the diaphragm, which may also coexist.…”