Corresponding author: M Ndlovu (meendlovu@gmail.com)
A pulmonary pseudocyst is defined as a cyst that lacks respiratory
epithelial cells. Lung pseudocysts are rare lesions in children and
their classification is usually combined with other parenchymal cystic
lesions. The distinction between a pseudo and a true cyst is difficult
to distinguish both in utero and postnatally. Radiological
investigations such as x-ray and computed tomography (CT) are equally
non-specific. Most literature focuses on pseudocysts in adults
particularly following blunt or penetrating chest trauma.
In this report, we narrate a case of a lung pseudocyst initially
misdiagnosed as a congenital lobar over-inflation in a child who
presented with progressive shortness of breath and failure to thrive.
Case:
K. X was a 2 year 5 months old male who presented to the district
hospital with shortness of breath and mild chest retractions since 8
months of age. There was no history of trauma to the chest. He had been
seen at the local clinic on two occasions and was managed as a pneumonia
with oral antibiotics. There was no resolution of symptoms, but the
caregiver did not seek further care because the child was active as she
had been advised that the child would improve with age. At the 18-month
immunisations follow up visit, he was noted to have growth faltering and
was placed on nutritional supplements. The shortness of breath
progressively worsened and they presented to the district hospital where
the child was admitted. He was noted to be in moderate respiratory
distress, emaciated with an oxygen saturation of 88% in room air that
improved to 100% on 2L oxygen via nasal canula. In addition, he had
clubbing, with a symmetrically hyperinflated chest.
A CXR at the district hospital revealed a hyperlucent right lung with
mediastinal shift to the contralateral side. (Fig 1) A diagnosis
of right sided pneumothorax was made, and an intercostal chest drain
(ICD) was inserted. There was no clinical or radiological improvement
after ICD insertion and a suspicion of congenital lobar over-inflation
was made. The patient was then transferred to a tertiary hospital for
paediatric pulmonology assessment where he was noted to be in moderate
respiratory distress with markedly reduced breath sounds bilaterally.
The ICD had slipped out during transfer but the patient’s clinical
condition had remained stable.