Case 17

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
This is a 9 year old male status post most vehicle accident causing a left pneumothorax, right hemothorax, bilateral lung contusions, liver laceration, bilateral clavicle fractures and a closed head injury. He was treated at an outside hospital where he received bilateral chest tubes, peritoneal lavage and repair of the liver laceration. He was then transferred to our institution for further management of his lung disease.

Clinical Physical Exam:
Respiratory distress.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Pulmonary contusion, pneumatocele, lung abscess.

Imaging Findings:
Supine chest films obtained in the intensive care unit on the 6th hospital day upon transfer to our institution were not felt to clearly delineate the pathology in the right lung, but did delineate the bilateral clavicle fractures. Therefore, an enhanced chest CT exam was obtained on the 7th hospital day and revealed a 4.5 cm in diameter complex cystic mass in the right lung, multiple left sided rib fractures, a large liver hematoma, and bilateral clavicle fractures.

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Imaging Differential Diagnosis:
Traumatic pneumatocele

Operative Findings:
None

Pathological Findings:
None

Final Diagnosis:
Pulmonary Contusion / Pneumatocele, Post Traumatic

Follow-up and Prognosis:
The patient's pulmonary contusion and pneumatocele cleared over several weeks and the patient did well.

Similar Cases:
Case 64

References:
None

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