CHEST Guidelines-A-65-Year-Old-Man-With-Concerns-of-Hemoptysis-Afte

A-65-Year-Old-Man-With-Concerns-of-Hemoptysis-Afte

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A 65-year-old man who recently experienced a motor vehicle accident came to the emergency department (ED) with hemoptysis, presenting as blood-tinged phlegm, which worsened over three days. Initially evaluated at a trauma center, imaging revealed no acute abnormalities. However, after discharge, the patient began coughing up increasing amounts of blood. He had no significant history of malignancy or infections, although he had a history of smoking and mild alcohol consumption.<br /><br />Upon examination in the ED, he had mild swelling and ecchymosis around the face and chest, but was otherwise stable with normal vital signs and clear lungs. Laboratory tests, including CBC and coagulation profiles, were normal, though B-type natriuretic peptide and troponin T levels were elevated. CT angiography of the chest identified cystic lesions in the right lung, with surrounding consolidation.<br /><br />The diagnosis was identified as traumatic pulmonary pseudocyst (TPP), a rare condition resulting from blunt chest trauma. It arises due to sudden lung compression and decompression during trauma, leading to lung tissue laceration and the formation of air or fluid-filled cysts. Though typically asymptomatic, TPP can cause symptoms like cough and hemoptysis. While chest X-rays can miss TPP, CT scans are more effective for diagnosis.<br /><br />Management of TPP is usually conservative, involving monitoring rather than surgical intervention, as the lesions often resolve naturally over months. The patient was stable during observation in the ED and discharged with levofloxacin to treat potential infective complications. He was advised to undergo follow-up imaging to track the resolution of the pseudocyst, although he was lost to follow-up.<br /><br />Clinical recommendations emphasize considering TPP in cases of acute chest trauma presenting with lung cystic lesions, ensuring unnecessary invasive procedures are avoided unless complications arise.

Keywords

traumatic pulmonary pseudocyst

blunt chest trauma

hemoptysis

cystic lung lesions

CT angiography

conservative management

lung tissue laceration

motor vehicle accident

smoking history

levofloxacin treatment