Posttraumatic pulmonary pseudocyst: computed tomography findings and management in 33 patients.

BACKGROUND

Posttraumatic pulmonary pseudocyst (PPP) is a complication of blunt chest trauma and poorly documented. A retrospective review of PPPs observed during the past 6 years in our hospitals is presented in this report.

METHODS

We retrospectively studied the serial chest computed tomographic scans and clinical data of 33 consecutive patients with PPPs.

RESULTS

Fifty-three PPPs from 33 patients were found. Thirty-six PPPs were located in the subpleural pulmonary parenchyma, whereas others were located in the pulmonary parenchyma near other harder structures. Follow-up examinations demonstrated that air-filled cavities and air-fluid cavities could turn into pulmonary hematomas and eventually resolved without specific treatment. The PPPs were resolved in 11 to 82 days. The resolving time of air-fluid cavity (mean, 47.5 days) was significantly longer than the resolving time of air-filled cavity (mean, 16.3 days; p = 0.001). Three patients died of acute respiratory distress syndrome or head trauma. No patient died of PPP. Twelve patients with serious pneumothorax, hemothorax, or both were cured with surgical hemostasis and/or drainage. Eighteen patients resolved without specific treatment.

CONCLUSION

Computed tomography increased the frequency of PPP diagnosis and accurately demonstrated the characteristics of the lesions. Air-filled pseudocysts resolved more quickly than those containing fluid. The outcome of PPPs can be favorable without specific treatment. PPP does not require follow-up CT scan or intervention in the absence of complications.

LEVEL OF EVIDENCE

Prognostic/epidemiologic study, level V.