Pneumatocele



Pneumatocele


Eric J. Stern, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Traumatic Pneumatocele


  • Postinfectious Pneumatocele


  • Bullous Emphysema


  • Paraseptal Emphysema


  • Tuberculosis


Less Common



  • Lung Abscess


Rare but Important



  • Hydrocarbon Aspiration


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Proper history of trauma or prior infection is paramount


Helpful Clues for Common Diagnoses



  • Traumatic Pneumatocele



    • Result from laceration of lung tissue


    • Penetrating injury; stab wound, gunshot wound


    • Blunt injury



      • Small, peripheral lacerations from overlying rib fractures


      • Paravertebral lacerations from shearing injury


      • Central lacerations from compression rupture; larger and more irregular in shape


    • Often initially obscured by surrounding pulmonary contusion/hemorrhage


    • Can initially present filled with blood (hematoma); fills with air as blood clears


    • Resolve/heal without treatment over 1-2 weeks


  • Postinfectious Pneumatocele



    • Common after Staphylococcus and Coccidioides infections


    • Thin walled


    • Pneumatocele can persist for years


  • Bullous Emphysema



    • Underlying centrilobular emphysema


    • Emphysematous spaces > 1 cm


  • Paraseptal Emphysema



    • Peripheral lung along fissures and sharp pleural reflections


  • Tuberculosis



    • Other features of nodular scarring, bronchiectasis, volume loss, ipsilateral tracheal deviation


    • Typically unilateral, upper lobe/apical


Helpful Clues for Less Common Diagnoses



  • Lung Abscess



    • Patients more acutely ill; fever, cough, chest pain


    • Ill-defined walls


    • Air-fluid levels common


Helpful Clues for Rare Diagnoses

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Aug 8, 2016 | Posted by in CARDIOLOGY | Comments Off on Pneumatocele

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