Pneumatoceles

Case contributed by Dr Rodney Strahan

Presentation

Tachypnea, cough and fever.

Patient Data

Age: 2 months
Gender: Male
X-ray

Initial airspace opacity in both lower zones, more extensive on the left.

Given the history and imaging findings, the patient was treated for pneumonia. Symptoms were slow to resolve with treatment and progress images demonstrate development of thin walled cystic spaces in both lower zones.

X-ray

CXR 1 week after initial CXR

Initial airspace opacity in both lower zones, more extensive on the left. 

Given the history and imaging findings, the patient was treated for pneumonia. Symptoms were slow to resolve with treatment and progress images demonstrate development of thin walled cystic spaces in both lower zones.

X-ray

CXR 2 months later

Initial airspace opacity in both lower zones, more extensive on the left. 

Given the history and imaging findings, the patient was treated for pneumonia. Symptoms were slow to resolve with treatment and progress images demonstrate development of thin walled cystic spaces in both lower zones.

Case Discussion

The following theories have been proposed as to the mechanism of post pneumonic pneumatocele formation; however, the exact mechanism remains controversial.

1. The initial event is inflammation, with narrowing of the bronchus, leading to the formation of an endobronchial ball valve. Ultimately, this bronchial obstruction leads to distal dilatation of the bronchi and alveoli.

2. A peribronchial abscess forms and subsequently ruptures its contents into the bronchial lumen. This also acts similarly to a ball-valve obstruction in the bronchus and leads to distal dilatation.

3. Pneumatoceles are caused by bronchial inflammation that ruptures the bronchiolar walls and causes the formation of "air corridors." Air dissects down these corridors to the pleura and forms pneumatoceles, a form of subpleural emphysema.

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Case information

rID: 53953
Case created: 15th Jun 2017
Last edited: 27th Sep 2017
Systems: Chest, Paediatrics
Inclusion in quiz mode: Included

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