A Spontaneous Pneumatocele Presenting with External Auditory Canal Obstruction / 대한이비인후과학회지

A pneumatocele is an air-filled cavity in the body. In the head and neck areas, the extensive hyperpneumatization of the temporal and occipital bones is typically associated with pneumatocele formation, which results in the spontaneous collection of gas, usually air, beneath the pericranium or within the skull. We herein report a case of stenosis of the external auditory canal caused by a left mastoid pneumatocele in a 12-year-old boy who was successfully treated with left simple mastoidectomy and canaloplasty.

Pseudocisto pulmonar pós-traumático em jogador de futebol: relato de caso / Post-traumatic pulmonary pseudocyst in a soccer player: a case report

Pseudocistos pulmonares são lesões raras que se desenvolvem no parênquima pulmonar após traumas fechados e de grande energia, cujo diagnóstico se baseia na associação da história clínica com exames de imagem. Relata-se a seguir um pseudocisto pulmonar ocorrido no parênquima contralateral ao trauma em um homem de 31 anos que apresentou episódio de hemoptise após queda durante partida de futebol.

Pulmonary pseudocysts are uncommon cavitary lesions that develop in the lung parenchyma as a consequence of blunt thoracic trauma, whose diagnosis is based on an association of clinical history and imaging findings. The present report describes the case of a pulmonary pseudocyst observed in the parenchyma contralateral to the trauma site in a 31year-old man presenting with hemoptysis after falling during a soccer match.

Clinical Manifestation of Necrotizing Pneumonia in Healthy Children

OBJECTIVE: Necrotizing pneumonia (NP) is a severe complication of lobar pneumonia caused by various pathogens. The immunopathogenesis and clinical characteristics of NP in children are not clearly understood. We wanted to evaluate the clinical characteristics and suggest in part the immunopathogenesis of NP. METHODS: We reviewed retrospectively the medical charts and radiographic materials of eight patients with NP, who were diagnosed by chest radiography and chest computed tomography at the Department of Pediatrics, Soonchunhyang University Hospitals at Cheonan and Bucheon from January 2002 to December 2011. RESULTS: They were previously healthy, 2.1 to 4.6 years of ages (mean, 2.8+/-1.0 years) and three boys and five girls. All of them had pleural effusion. Five patients had pneumonic consolidations in right upper lung field. Three patients had pneumatocele. They developed leukocytosis (mean, 19,400+/-6,400/mm3), higher C-reactive protein level (mean, 25.1+/-8.0 mg/dL). The etiologic agents were revealed in two patients; Streptococcus pneumonia (S. pneumonia) was revealed in one patient and S. pneumonia and Mycoplasma pneumonia in the other patient. Three patients were treated with additional intravenous immunoglobulin. Clinical improvement was prolonged: fever lasted 10 to 23 days, and length of hospitalization was 15 to 36 days. NP or pneumatocele were completely resolved on the follow-up radiographic studies in all of the patients. CONCLUSION: Although the previously healthy young children with NP had protracted clinical course, they recovered without any problematic sequelae. Our results suggest that the immunopathogenesis of NP in children may be associated with the exaggerated immune reaction of the host to insults from initial bacterial infections, rather than the pathogen-induced cytopathies.

Congenital cystic adenomatoid malformation in an adolescent: An unusual presentation with pleural effusion and pneumatocele.

Congenital cystic adenomatoid malformation (CCAM) encompasses a continuum of hamartomatous cystic lung lesions characterised by the presence of abnormal bronchiolar structures of varying sizes or distribution. The CCAM is a disorder of infancy with majority of the cases being diagnosed within the first two years of life. We describe CCAM in a 13-yearold girl complaining of recurrent lower respiratory tract infections since infancy who presented with post-infectious pneumatocele with loculated pleural effusion, and suspected abscess formation and had undergone resection.

Pneumonia complicada por pneumatocele gigante em criança com síndrome da imunodeficência adquirida: importância da fisioterapia respiratória / Pneumonia complicated by a giant pneumatocele in a child with acquired immunodeficiency syndrome: importance of chest physiotherapy

OBJETIVO: Descrever os efeitos do tratamento fisioterapêutico na prevenção de complicações respiratórias de uma criança com síndrome da imunodeficiência adquirida, que apresentava pneumatocele gigante. DESCRIÇÃO DO CASO: Criança com oito anos de idade, do sexo feminino, encaminhada para acompanhamento fisioterapêutico em hospital universitário devido a quadro de hipersecreção pulmonar, histórico de pneumonias e presença de pneumatocele gigante. A conduta fisioterapêutica incluiu técnicas de higiene brônquica ativa, envolvendo fluxo aéreo expiratório, com o intuito de promover a desobstrução pulmonar sem causar risco de complicações à criança. O seguimento foi multiprofissional e direcionado à prevenção de infecções recorrentes e de ruptura da bolha, que tornariam necessária a internação hospitalar. Durante o acompanhamento, o quadro pulmonar manteve-se estável, sem aumento ou ruptura da pneumatocele, radiograficamente visível. COMENTÁRIOS: A atuação da fisioterapia respiratória nos casos de pneumatocele gigante não está definida na literatura. Não há, até o momento, evidências de seus efeitos benéficos, bem como diretrizes a respeito dos métodos mais eficientes e seguros. Ao contrário, muito se discute sobre os riscos e complicações decorrentes dessa intervenção. No presente caso, a assistência fisioterapêutica regular foi importante para garantir a estabilidade do quadro pulmonar da criança, sendo necessários estudos com desenho metodológico apropriado para verificação de eficácia clínica.

OBJECTIVE: To describe the effects of chest physiotherapy in preventing respiratory complications in a child with acquired immunodeficiency syndrome and a giant pneumatocele. CASE DESCRIPTION: An eight-year-old female child was sent to the physiotherapy service of a university hospital due to pulmonary hypersecretion, repeated pneumonias and presence of a giant pneumatocele. The physiotherapy team selected active airway clearence techniques and expiratory flow techniques to promote pulmonary hygiene and to reduce risks for respiratory complications. The follow-up around was accomplished by a multiprofissional team with the objective of avoiding recurrent pulmonary infections, pneumatocele's rupture and need for long-term hospitalization. The child's pulmonary condition remained stable and no changes in the size of the pneumatocele were seen in repeated X-rays. COMMENTS: The role of chest physiotherapy in patients with giant pneumatoceles is not well defined in the literature. There is no evidence of beneficial effects of this therapy and there are no guidelines that address the most efficient and safest techniques. Currently, much is discussed about the risks and complications arising from chest physiotherapy. In this case, regular physiotherapy intervention was important to maintain child's pulmonary integrity, but studies are needed to evaluate techiques and clinical relevant effects.

Delayed Progressive Extradural Pneumatocele due to Incomplete Sealing of Opened Mastoid Air Cell after Micro-Vascular Decompression

A case of delayed progressive extradural pneumatocele after microvascular decompression (MVD) is presented. A 60-year-old male underwent MVD for hemifacial spasm; the mastoid air cell was opened and sealed with bone wax during surgery. One month after surgery, the patient complained of tinnitus, and progressive extradural pneumatoceles without cerebrospinal fluid (CSF) leakage was observed. Revision surgery was performed and the opened mastoid air cell was completely sealed with muscle patch and glue. The patient's symptoms were resolved, with no recurrence of pneumatoceles at 6 month follow up. Progressive extradural pneumatocele without CSF leakage after posterior fossa surgery is a very rare complication. Previous reports and surgical management of this rare complication are discussed.

Staphylococcus epidermidis Necrotizing Pneumonia and Pneumatocele in a Term Infant

Staphylococcus epidermidis is emerging as an increasingly important pathogen in the immunocompromised host. We report here a case of S. epidermidis necrotizing pneumonia complicated by pneumatoceles in a term male infant who had earlier undergone surgical repair of tracheo-esophageal fistula. He was treated with intravenous teicoplanin and gentamicin for four weeks followed by two weeks of erythromycin. No percutaneous aspiration or pleural drainage was required. He had complete clinical and radiologic recovery when seen at follow-up six months later. Aggressive antimicrobial therapy for this condition without surgical drainage resulted in complete resolution and avoided complications such as pneumothorax and bronchopleural fistula.

A Clinic Research About Bronchoscopic Lung Volume Reduction By ?-cyanoacrylate / 中国实用内科杂志

Objective To research the method and effect about the bronchoscopic lung volume reduction by ?-cyanoac- rylate in the therapy of chronic obstructive pulmonary disease (COPD).Methods The 14 patients had been examined bosoms by CT before the operation and determined the type of emphysema and the distributing of pneumatocele,had blood gas analyzed and pulmonary function checked.The operation was carried through trachea cannula and intravenous anesthe- sia.When the bronchoscope came to the goal bronchia,we infused the meglumine diatrizoate through the biopsy orifice and approved the location of pneumatocele forward。Then,we infused erythromycin and ?-cyanoacrylate in turn through the biopsy orifice by silica del tube.Results The 3 pneumothorax patients had been removed the drainage tube in 3 days af- ter the operation.8 cases had been counterchecked sternite in one week and the pneumatocele was just like before,among which,1 case developed exudation.1 case had shown pleural thickening in the right-up lung counterchecked sternite 9 months later.1 case been checked the pulmonary function,the FEV_1 enhanced from 24.7% pred before operation to 32. 9% pred after operation one week.3 cases felt polypnea improved greatly and 7 cases felt polypnea improved a little.Con- clusion The bronchoscopic lung volume reduction by ?-cyanoacrylate is a safe,effective and economical method in the therapy of COPD.

Two Cases of Community Acquired Necrotizing Pneumonia in Healthy Children / 소아알레르기및호흡기학회지

Necrotizing pneumonia is a complication of severe, sometimes fatal, lobar pneumonia that leads to extensive necrosis of lung parenchyme. The plain chest X-ray shows many small lucencies and pneumatoceles while the chest CT demonstrates cavities, that do not show contrast enhancement. Major bacteriae that cause necrotizing pneumonia are anaerobes in immune deficient patients and nosocomial infections, and Streptococcus pneumoniae and Mycoplasma pneumoniae in children of healthy environments. Cases of necrotizing pneumonia in children, unlike those observed in adults, show less need for invasive surgery and lead to a favorable outcome once an early diagnosis is made and a course of appropriate antibiotics is initiated. Empirical antibiotic treatment is important because the specific causative agent may not be found. We report two cases of successful treatment of healthy children who had lung abscesses combined with extensive necrotizing pneumonia.

Infected Pneumatocele Following Anaerobic Pneumonia in Adult

We report a case of an infected pneumatocele in the course of anaerobic pneumonia in an adult. To the best of our knowledge, anaerobic pneumonia complicated by a pneumatocele in an adult has not previously been described. The pneumatocele occurred on the fifth day of hospitalization, and rapidly increased in size, with the development of a subsequent mixed anaerobe infection. A pig-tail catheter was inserted and the pus drained. The bacterial culture from the pus was positive for three anaerobes: Bacteroid species, Peptostreptococcus asaccharolyticus and Fusobacterium species. Intravenous antibiotics and percutaneous catheter drainage resulted in a successful treatment.

Pneumatocele Caused by Enterobacter cloacae in the Preterm Neonates

Enterobacter cloacae, a gram negative bacillus is an increasingly frequent cause of nosocomial pediatric infection. It can cause infection of postsurgical wounds, meningitis, and infection of the gastrointestinal, urinary, and respiratory tracts. Newborn infants often are colonized by Enterobacter species in the gastrointestina tract or respiratory tract soon after birth, and a acquisition of hospital strains in immunocompromised newborn infants is common. Neonatal pneumonia has been associated with many infectious agents. Pneumatocele, a cyst-like lesion that develops within the lung parenchyma, is an unusual complication of pneumonia in the neonate, especially in the preterm neonate. Pneumatocele has been reported to occur with Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, and Pseudomonas aeruginosa infections. We describe 2 cases of premature neonates with pneumonia and subsequent pneumatocele formation caused by Enterobacter cloacae.

Intracerebral Tension Pneumatocele as a Complication of Fronto-ethmoid sinus Osteoma: Case Report

A case of intracerebral tension pneumatocele as a complication of an Osteoma in the Fronto-ethmoid sinus is reported. The commonest causes of intracranial air are head trauma and neurosurgical procedures. Less common etiologies include infection due to gas-forming organisms, mucoceles, tumors(e.g. osteomas carcinomas pituitary adenomas peripheral nerue tumors) and congenital neurenteric cysts or dural defects. Computed tomography permitted rapid diagnosis including localization of the air thus facilitating prompt treatment.