Fig 5. CXR on follow-up showing re-expansion of the right lung
Discussion
Pulmonary pseudocysts are often a sequela of blunt trauma to the chest
wall, although cases following penetrating injuries to the chest have
also been described. (1) Blunt chest trauma often
results in lung contusions and lacerations, but rarely cystic lesions.(2) Traumatic pulmonary pseudocysts often occur within
24 hours after the injury, may be single or multiple and are usually
self-limiting with an excellent prognosis. (3)Multiple pseudocysts have also been reported in neonates with hyaline
membrane disease on continuous distending pressures from mechanical
ventilation. (4) A previous case reported a 7-year-old
who had multiple cysts that complicated with a pneumothorax. Histology
revealed inflammatory cell infiltrate in the interstitium, alveolar
haemorrhage and cysts that lacked an epithelial lining.(5) Pseudocysts with predominant inflammatory
processes have also been seen in smokers, asthmatics and in cystic
fibrosis patients. (6). (7) In our
case, previous inflammation could not be excluded, even though no
inflammatory cells were observed. Moreover, post inflammatory cysts are
usually multiple and small, (7) but our case had a
giant single cystic lesion. Some authors have lumped pseudocysts with
congenital cystic lung lesions under a broader group of cystic and
pseudocystic pulmonary malformations. (CPPM) (8) Most
CPPM lesions disappear in utero and are generally asymptomatic but may
be responsible for fetal death, early life respiratory distress,
recurrent pulmonary infections, or can transform to malignant lesions.(8) It is challenging to make a distinction between
cystic and pseudocystic pulmonary lesions radiologically, on chest
radiography or HRCT. Definitive diagnosis of a pseudocyst is only
possible histopathologically, where the absence of epithelial cells or
lung tissue is diagnostic of a pseudocyst. The management of congenital
pulmonary airway malformation in asymptomatic children is controversial,
some adopt a wait-and- see approach while others prefer a more
aggressive approach of surgical excision to avert the risk for malignant
transformation. In symptomatic patients, it is prudent to excise the
cyst to achieve symptom relief. In our case, the pseudocyst was excised
to relieve the compressive effects on adjacent lung tissue.
Conclusion
This case describes a rare case of a spontaneous pulmonary pseudocyst in
a 2-year-old child. To the best of our knowledge, this is the first such
case to be reported in literature.
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