Traumatic pulmonary pseudocyst
A 26 year old unmarried male was referred to us with history of left sided chest pain for two days. He had consulted at local hospital immediately after trauma. A skiagram chest taken there [] showed non homogenous opacity with central lucency in the region of left hilum. On examination, the patient was afebrile. Except for a few abrasions on anterior chest wall, general examination and respiratory system examination was normal.\nThe patient gave history of trauma - a tractor wheel hitting him on the anterior chest wall, while he was lying down; following which he developed the pain. There was no history of breathlessness, fever, cough, hemoptysis, cough or expectoration. There was no history suggestive of bronchial asthma or exposure to pets at home or work place. A repeat chest X ray on 31/08/2011 showed cavitations in the left hilar region. The margins of the lesion were now thinned out and smooth [].\nHis sputum for AFB was negative. Gram stain showed few gram positive cocci but was sterile on culture. A mantoux test was done and read 8 mm at end of 72 hours. Other lab investigation revealed haemoglobin 14.4, leukocyte count 7900, and differential count of 78 % polymorphs and 19% lymphocytes. His total eosinophilic count was 88/cc. His serum was non reactive for HIV antibodies. A CT scan of thorax done on 03-09-2011 showed a single smooth walled cavity abutting left chest wall with surrounding areas of ground glass haziness, probably suggestive of lung contusion [].\nFibre optic bronchoscopy was performed to achieve a microbiological diagnosis and to inspect the trachea-bronchial tree in view of previous reports being inconclusive. Bronchoscopy revealed a bleeding spot in left main bronchus, but no active bleeding was seen. Bronchial brushings taken from left upper lobe were negative for malignant cells and AFB, and the lavage fluid also was sterile. In view of the patient's history of ancedent recent trauma, negative past and present history for any infectious process, and negative microbiological reports, a diagnosis of Post traumatic pulmonary pseudo cyst (TPP) was made. The patient was reassured and advised analgesics and bed rest for 3 days. Serial follow up chest skiagram showed rapid resolution of the cavities [] without any antibiotics, thus confirming our diagnosis of TPP.