An Unusual Pulmonary Condition Presenting following Trauma

Abstract

An 18-year-old man presented to the emergency department following an assault. He complained of left-sided pleuritic chest pain and difficulty breathing. Clinical examination revealed reduced air entry and coarse crepitations at the left lung base. A chest x-ray showed a large opacity at the left lung base that contained multiple cystic areas with air-fluid levels. Due to the history of trauma, a provisional diagnosis of a ruptured hemidiaphragm with small bowel herniation was made. Further imaging, including ultrasound, spiral computed tomography and magnetic resonance angiography, showed an aberrant vessel supplying the opacity and drainage into the pulmonary venous system. A diagnosis of a bronchopulmonary sequestration (intralobar type) was made. The differential diagnosis of the radiographic appearance is also discussed.

Acute Hemoptysis and Pulmonary Hemorrhage after Judo as Presentation of Intralobar Sequestration

“…1 Symptoms like hemoptysis and hemothorax are rare and are described as indicators for even fatal outcome in nontrauma conditions. 2,3 In our case, hemoptysis can be explained by traumatic disruption of ILS into the lower lobe. The association of ILS with funnel chest might have been a predisposing factor for disruption due to the smaller retrosternal space in lung or other organ trauma.…”

“…6 However, the crucial part of all surgical procedures is the identification and control of the aberrant vascular supply. In the emergency setting of acute bleeding, the resection of PS via thoracotomy seemed to be the safest and therefore the only reasonable treatment 3,7 whereas thoracoscopic approaches should be recommended in elective cases.…”