Abstract / Summary
Traumatic pneumatoceles are uncommon pulmonary pseudocysts that may occur following blunt thoracic trauma and can be entirely occult on chest radiography, potentially mimicking other cavitary lung pathologies. We present the case of a 52-year-old male transferred to a tertiary trauma center following a motorcycle accident. On presentation, the patient was hypoxic with extensive right-sided chest wall injuries. Initial supine chest radiography demonstrated multiple right-sided rib fractures, patchy airspace opacities, a veiling opacity, and a suspected pneumothorax, raising concern for a large right hemopneumothorax. Subsequent computed tomography (CT) imaging clarified the injury, revealing only a small right hemopneumothorax alongside pulmonary contusions and numerous diffuse, thin-walled subcentimeter cystic cavitations throughout the right lower lobe, with a solitary left lower lobe lesion, consistent with traumatic pneumatoceles not appreciated on the radiograph. With the extent of injury clarified on CT, the patient was initially managed conservatively, later requiring intercostal catheter insertion and operative rib fixation due to worsening hemothorax and increasing oxygen requirements. Follow-up CT imaging at 4 weeks demonstrated complete resolution of the pneumatoceles. This case highlights a key radiological pitfall in the assessment of traumatic pneumatoceles on supine chest radiography, the characteristic CT appearances and the importance of accurate radiological diagnosis in guiding safe management.