Cerebral Infarct Complicating Traumatic Pneumatocele: A Rare Sequela Following Blunt Chest Trauma

Abstract

Systemic air embolism is known to rarely complicate blunt chest trauma. However, cerebral infarction caused by air emboli possibly originating from a traumatic pneumatocele has not been previously reported. We report a case of a 46-year-old woman who sustained blunt chest trauma with multiple rib and clavicular fractures, hemothorax and a huge, tense traumatic pneumatocele. She subsequently developed clinical and radiologic features of cerebral infarction. The cerebral infarct is likely to be secondary to cerebral air embolism originating from a traumatic pneumatocele.

Cerebral air embolism associated with penetrating lung injury: a case report and review of the literature

“…Especially in trauma, the air shadow often disappears during the initial resuscitation treatment, imaging tests, surgery, and ventilator management 4, 7. Therefore, CAE could be suspected as a diagnosis of exclusion in the absence of intravascular air shadows.…”

“…The remaining seven cases received chest compressions for resuscitation (Table 1). [2][3][4][5][6][7][8] Penetrating chest trauma could be a rare cause of late-onset CAE. As the reason, we speculate that blunt chest trauma is pathologically severe and includes lung contusion whereas penetrating trauma often remains as a localized injury.…”

Resolution of Traumatic Pneumatocele Due to Penetrating Thoracic Trauma

“…Kesieme et al report a case who sustained blunt chest trauma with a huge, tense traumatic pneumatocele which lead to cerebral infarction [7]. But usually TPs resolve spontaneously without complication.…”

Traumatic pneumatocele in an 11-year-old boy – report of a rare case and review of the literature

“…A pneumatocele is defined as a thin-walled air-filled cyst of the lung that is most often seen in children with bacterial pneumonia, but can also develop after blunt thoracic trauma, positive-pressure ventilation, or caustic aspiration [2]. The occurrence of a traumatic pneumatocele after a chest injury is rare; it requires a violent impact directed on a pliable chest wall (as seen in this age group), so that kinetic energy is transmitted to the underlying pulmonary parenchyma [3]. The condition is characterized by the appearance of pulmonary cavities with no epithelial lining, filled with air, fluid, or blood, which can be observed on radiological imaging.…”

“…More complicated cases may give rise to questions concerning the optimal management, because not many pediatric cases are described in the literature. There are reports of complications associated with traumatic pneumatoceles, including secondary infection and hemoptysis [3, 8]. For complicated cases, complete resection is recommended [3, 9].…”