Posted by James
To our knowledge, this case is the first report of bilateral post-traumatic paramediastinal lung cysts. Furthermore, it illustrates several characteristic features of this condition. All patients have a history of blunt chest trauma, which may be minor. over 80 percent are 30 years of age or less, with no previous pulmonary complaints. Many patients present with hemoptysis, chest pain, cough, and dyspnea. there may be a low-grade fever with mild leukocytosis.
A number of factors have been implicated as important mechanisms of injury. Initially, a blunt force applied to the chest wall results in compression and high pressures within the underlying pulmonary parenchyma. This may lead to the rupture of small bronchi, causing the surrounding alveoli to burst. Air can then enter between the layers of the pulmonary ligament. Rupture of capillaries around the lacerated alveoli then leads to accumulation of blood within the newly formed air space. A closed glottis may play a role in producing high intrathoracic pressure from chest compression. The bursting process may involve any area of either lung, although the apices are usually spared. An alternative theory proposes that a blow to the chest wall creates a concussive wave, leading to shearing stresses which exceed the elasticity of the pulmonary tissue. Still another proposal notes that increased intrathoracic pressure may be followed by negative pressure due to elastic recoil after compression. This might produce bursting followed by shearing forces, leading to parenchymal lacerations, and escape of air and fluid into the lung.
The differential diagnosis includes postinfectious pneumatocele, tuberculous or mycotic cavity, pulmonary abscess, cavitating carcinoma, cavitating or infected hematoma, and ruptured diaphragm with protrusion of bowel into the chest space. these are differentiated by the history of trauma, absence of preceding respiratory symptoms, and the absence of crackles and borborygmi upon chest auscultation. Obtaining upright and decubitus chest roentgenograms, barium swallow with small-bowel follow-through, barium enema, or CT scan of the chest may exclude ruptured diaphragm with intrathoracic bowel herniation. This is most important to prevent unnecessary surgery, as occurred in this patient and described by others in patients with only unilateral lung cysts. canadian antibiotics
The chest roentgenogram may reveal post-traumatic lung cysts upon initial presentation, or they may develop several days later. The often immediate or rapid evolution of these cysts reinforces the concept that they occur as primary trauma pathology and not as a result of infection or resolving pulmonary hematoma.
This case was complicated by the presence of HIV antibody and the absence of previous reports of bilateral post-traumatic paramediastinal lung cysts. Pulmonary abscesses have been observed in patients with the acquired immunodeficiency syndrome. in contrast to the findings in this case, these patients present with prolonged systemic signs and symptoms and do not have a history of recent blunt chest trauma.
The clinical course of traumatic pulmonary and paramediastinal cysts is usually benign, requiring only supportive therapy; however, in-hospital observation is recommended because deterioration due to pulmonary contusion and hypoxia may occur. Superinfection occurs rarely, and prophylactic antibiotics are not indicated. if formation of an abscess does occur, specific antibiotic therapy should be instituted. Hemoptysis may persist for several days, but the cavity usually heals over the course of 2 to 16 weeks. Conservative management should be continued if the lesion continues to decrease in size at six weeks after injury in adults or three to four months after injury in children. if the cysts become infected or expand, opening and fenestration, transthoracic suction drainage, or lobectomy may be indicated. kamagra soft tablets
Several concepts illustrated by this case merit emphasis: (1) It may be difficult to detect the subtle but pertinent abnormalities on initial emergency-room chest roentgenograms. (2) the minor clinical but major radiographic findings must be contrasted with the status of most patients with a ruptured diaphragm, who usually have other injuries and are seriously ill. (3) Absence of bowel sounds upon chest auscultation is an indication for further imaging studies, if the patient s clinical condition permits. Remembering these key points will facilitate appropriate diagnosis and prevent unnecessary surgery.