Abstract Introduction Traumatic pneumatocele is a rare complication of chest wall trauma. It typically presents as a cavitary lesion adjacent to chest wall trauma. Most cases occur in children with only 15-25% of cases occur in patients greater than 30 years old 1,2. We present a middle-aged male with traumatic pneumatocele. Case Presentation A 39-year-old male presented to the Emergency Department after an assault. The patient reported that several hours prior to ED arrival, two people hit his right chest with a bat repeatedly and he had been experiencing continuous pleuritic chest pain since the assault. Initial BP 142/89, heart rate 89, pulse ox 98%. Chest x-ray at presentation showed acute displaced fractures of the right 6-10 ribs with a right apical pneumothorax and right pleural effusion. CT scan showed multiple air filled cavitary structures, likely representing posttraumatic pneumatoceles, within the right lower lobe with adjacent acute rib fractures. An additional review of systems was obtained after identifying the cavitary lesion. The patient denied fever and unintentional weight loss but endorsed dry cough of unspecified duration. His disclosed social history included sexual activity with both males and females as well as recent crack cocaine use via inhalation but no intravenous drug use. He has never been in jail for extended periods of time. The patient was admitted to the trauma service and was evaluated by the infectious disease (ID) consult service during admission. ID noted that the presumed pneumatoceles are often due to previous bacterial PNA causing lung injury, or previous chest wall trauma. As such, they recommended the patient complete a 5-day course of community acquired pneumonia empiric coverage. The patient was discharged on hospital day 5 with pain control medications and primary care follow up. Discussion Spontaneous resolution of traumatic pneumatocele typically occurs within 4 months and without surgical intervention2. This patient was managed conservatively for his pneumatoceles and thus far has had no documented complications, however, he has had several presentations back to the ED for pain management. Physicians recognizing pneumatoceles as a traumatic entity is beneficial for resource management as it may decrease clinical uncertainty and unnecessary infectious workups. 1. Sorsdahl OA, Powell JW. Cavitary pulmonary lesions following non-penetrating chest traum in children. Am J Roentgenol 1965;95:118—24. 2. Chon SH, Lee CB, Kim H, Chung WS, Kim YH. Diagnosis and prognosis of traumatic pulmonary psuedocysts: a review of 12 cases. Eur J Cardiothorac Surg. 2006;29:819-823. doi: 10.1016/j.ejcts.2006.01.054. This abstract is funded by: none
Cotton et al. (Fri,) studied this question.