Desrues B, Delaval P, Motreff C, Kernec J, Dormoy C, Pencolé C, Bergeron D, Malledan Y, Saint-Marc C
(1) Service de Pneumologie, Hôpital Pontchaillou, Centre Hospitalier et Universitaire, Rennes.
Rev Mal Respir. 1988;5(1):67-70.
Pneumatocele and haemato-pneumatocele are air or air/fluid cavitary lesions which develop in the lung parenchyma after thoracic trauma. The formation of this lesion requires a direct violent impact on the pliable lung wall which explains its frequency in young adults. They are preferentially localised in the lung bases. The importance of associated lesions often marks the pneumatocele. Though rarely described, its frequency is certainly underestimated. If haemoptysis is the most frequent clinical sign it is the chest x-ray which demonstrates the early abnormality in the form of a rounded translucent image with a fine contour and variable diameter. The existence of a fluid level suggests the presence of blood (haemato-pneumatocele). The differential diagnosis with a localised pneumothorax, a diaphragmatic hernia and a pre-existing cystic lesion is easy as a rule but an evacuated pulmonary haematoma may lead to the discussion, especially as the mechanism of their formation may be the same. In isolation their clinical implications are minimal, their evolution favourable and after several weeks with a restitution of the integrity of the pulmonary parenchyma the absence of therapeutic intervention is justified.
肺气囊和血气囊肿是胸部创伤后在肺实质内形成的含气或气/液空洞性病变。这种病变的形成需要对柔软的肺壁进行直接暴力撞击,这解释了其在年轻人中发病率较高的原因。它们多位于肺底部。相关病变的情况往往对肺气囊很重要。虽然很少被描述,但它的发病率肯定被低估了。如果咯血是最常见的临床症状,那么胸部X光片则能显示出早期异常,表现为轮廓清晰、直径可变的圆形透光影像。出现液平提示有血液存在(血气囊肿)。通常情况下,与局限性气胸、膈疝和既往存在的囊性病变进行鉴别诊断很容易,但排空的肺血肿可能会引发讨论,尤其是因为它们的形成机制可能相同。孤立存在时,它们的临床意义不大,病情发展良好,经过几周后肺实质恢复完整,无需进行治疗干预是合理的。