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.
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 he was 8 months old. 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.