Pneumatocele

Epidemiology

  • Definition: defined as cystic airspace within the lung which characteristically increases in size over days-weeks (probably due to ball-valve air trapping mechanism), but eventually resolves
  • Typically associated with infection (usually Staph Aureus)
  • Occur more commonly in children

Etiology

Infection-Associated Pneumatocele

  • Adenovirus (see Adenovirus, [[Adenovirus]])
  • Coccidioidomycosis (see Coccidioidomycosis, [[Coccidioidomycosis]])
  • Escherichia Coli (see Escherichia Coli, [[Escherichia Coli]]): uncommon etiology
  • Haemophilus Influenzae (see Haemophilus Influenzae, [[Haemophilus Influenzae]]): uncommon etiology
  • Klebsiella Pneumoniae (see Klebsiella Pneumoniae, [[Klebsiella Pneumoniae]]): uncommon etiology
  • Necrotizing Pneumonia (see Necrotizing Pneumonia, [[Necrotizing Pneumonia]])
  • Pneumocystis Jirovecii (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]]): cystic lesions are usually seen in HIV-associated cases, are more common in upper lobes, and range in size from 1-5 cm
  • Pseudomonas Aeruginosa (see Pseudomonas Aeruginosa, [[Pseudomonas Aeruginosa]]])
  • Serratia Marcescens (see Serratia Marcescens, [[Serratia Marcescens]])
  • Staphylococcus Aureus (see Staphylococcus Aureus, [[Staphylococcus Aureus]])
    • Pneumatoceles occur mainly in childhood cases
    • Case reports associated with Staph Aureus endocarditis with septic embolization
  • Streptococcus Pneumoniae (see Streptococcus Pneumoniae, [[Streptococcus Pneumoniae]]): uncommon etiology
  • Streptococcus Pyogenes (see Streptococcus Pyogenes, [[Streptococcus Pyogenes]]): uncommon etiology
  • Tuberculosis (see Tuberculosis, [[Tuberculosis]])

Toxin-Associated Pneumatocele

  • Hydrocarbon Aspiration Pneumonitis (see Hydrocarbons, [[Hydrocarbons]])

Traumatic Pneumatocele

  • Penetrating or Closed Chest Trauma
  • Ventilator-Associated Barotrauma (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])

Clinical

  • Asymptomatic Thin-Walled Cyst (see Cystic-Cavitary Lung Lesions, [[Cystic-Cavitary Lung Lesions]]): many cases
  • Tension Pneumatocele (Compression of Adjacent Structures): including compression of lung or mediastinal structures -> may be acute and life-threatening
  • Secondary Infection of Pneumatocele: may occur
  • Pneumothorax: may occur when pneumatocele ruptures into the pleural space

References

  • Observation: usually indicated, as pneumatoceles typically resolve sponatenously over weeks-months
    • However, cases with persistence up to 3 years have been reported
  • Pneumatocele Decompression: may be required in some cases
    • Tube Decompression: while may be acutely beneficial (with rapid decompression), may pose a risk for persistent bronchopleural fistula
    • Surgical Excision
  • Treatment of Associated Pneumothorax: if present

References

  • The origin of lung cysts in childhood. Arch Dis Child. 1951;26:504-529
  • On the natural regression of pulmonary cysts during early infancy. Pediatr. 1953;11:48-64
  • Staphylococcal pneumonia in infancy and childhood: Analysis of 75 cases. JAMA. 1958;168:6-16
  • Subpleural emphysema complicating staphylococcal and other pneumonias. J Pediatr. Aug 1972;81(2):259-66
  • Pneumococcal pneumonia with pneumatocele formation. Am J Dis Child. Nov 1978;132(11):1091-3
  • Solitary cavities of the lungs: diagnostic implications of cavity wall thickness. Amj J Roentgenol 1980; 135: 1269-271
  • Haemophilus influenzae type B pneumonia with pneumatocele formation. Clin Pediatr (Phila). Feb 1980;19(2):151-2
  • Persistent postpneumonic pneumatoceles in children. Chest. Mar 1981;79(3):359-61
  • Staphylococcal pneumonia in infants and children. Pediatr Infect Dis. Jan-Feb 1982;1(1):19-23
  • Pneumatocele in infants and children. Report of 12 cases. Clin Pediatr (Phila). Jun 1983;22(6):420-2
  • Pneumatocele formation in adult pneumonia. Chest. Oct 1987;92(4):717-20
  • Pulmonary pneumatocele: pathology and pathogenesis. AJR Am J Roentgenol. Jun 1988;150(6):1275-7
  • Traumatic pneumatocele. J Pediatr Surg. Dec 1992;27(12):1523-4
  • Pneumatocele complicating hyperimmunoglobulin E syndrome (Job’s Syndrome). Ann Thorac Surg. Dec 1992;54(6):1206-8
  • Primary staphylococcal pneumonia in childhood: a review of 69 cases. J Paediatr Child Health. Dec 1992;28(6):447-50
  • Staphylococcal pneumonia in childhood: will early surgical intervention lower mortality?. Pediatr Pulmonol. Aug 1995;20(2):83-8
  • Traumatic pneumatoceles in an infant: case report and review of the literature. Eur J Pediatr Surg. Apr 1996;6(2):104-6
  • Percutaneous catheter drainage of tension pneumatocele, secondarily infected pneumatocele, and lung abscess in children. Crit Care Med. Feb 1996;24(2):330-3
  • Serratia marcescens pneumonia, empyema and pneumatocele in a preterm neonate. Pediatr Infect Dis J. Oct 1997;16(10):1003-5
  • Management of tension pneumatocele with high-frequency oscillatory ventilation. Chest. Jan 2002;121(1):284-6
  • Mayo Clin Proc 2003; 78: 744-752
  • Pneumatoceles in postpneumonic empyema: an algorithmic approach. J Pediatr Surg. Jul 2005;40(7):1111-7
  • Complicated pneumonias with empyema and/or pneumatocele in children. Pediatr Surg Int. Feb 2006;22(2):186-90
  • Community-associated methicillin-resistant Staphylococcus aureus: reconsideration of therapeutic options. Curr Infect Dis Rep. Jan 2006;8(1):23-30
  • Cavitary pulmonary disease; Clin Microbiol Rev, 2008: 305–333
  • Necrotizing pneumonia complicated by early and late pneumatoceles. Can Respir J. Apr 2008;15(3):129-32
  • Pneumatoceles in preterm infants-incidence and outcome in the post-surfactant era. J Perinatol. Oct 8 2009