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Development of Post-Coital Pneumatocele in a Patient Who Had Previously Undergone Thoracotomy for Total Decortication Due to Empyema
Description
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A3609 - Development of Post-Coital Pneumatocele in a Patient Who Had Previously Undergone Thoracotomy for Total Decortication Due to Empyema
Author Block: A. C. Boulos1, J. Gordon2, J. Petty3; 1Pulmonary and Critical Care Medicine, Parkview Medical Center, Pueblo, CO, United States, 2Pueblo Pulm Associates, Pueblo, CO, United States, 3Parkview Medical Center, Pueblo, CO, United States.
Introduction:
Pneumatoceles, also known as posttraumatic pulmonary pseudocyts, are cystic parenchymal lung lesions that are the result of pulmonary injury. They are most often associated with lung cancer, tuberculosis, lung abscess related to Hyper IgE syndrome (Job’s syndrome), and Staphylococcus aureus pneumonia. Management usually involves supportive care and observation. In cases of infection or patient intolerance, antibiotics, catheter drainage, and surgical resection may be required.
Case Report:
We present a 56 year old white female with a past medical history most significant for chronic respiratory failure on 3 liters of oxygen at home, prior tobacco use, COPD, and previously treated left sided empyema. The patient had presented from an outside facility roughly 2 ½ years prior for definitive treatment of her empyema following chest tube placement. Staphylococcal infection was presumed based on sputum gram stain. The patient required surgical decortication via a VATS that required conversion to an open thoracotomy with prolonged and extensive removal of the rind, which was noted to be up to 1cm thick in some places. The patient had a complicated recovery but was eventually discharged home. She returned to our facility for a presumed right lower lobe pneumothorax seen on CT. The patient noted sudden, severe right lower chest/right upper quadrant pain during intercourse (the first time since her surgery over 2 years ago) roughly one week prior to presentation. She described feeling a “pop” with the pain and described its character as being similar to that of a prior “kidney infection”. Over the next week she reported progressively worsening pain and “small pops” with inspiration and developed hemoptysis three days prior to presentation. The patient’s symptoms became intolerable and she required VATS for resection of the pneumatocele.
Discussion:
Pneumatoceles are most often associated with children and tend to occur infrequently in adults. Frequently they are associated with pneumonia, Staphylococcus being a common organism. Large pneumatoceles are thought to result from the development of a “one way valve” following necrosis and rupture of the bronchiolar wall. To our knowledge this is the first reported case of pneumatocele development following intercourse.
Author Block: A. C. Boulos1, J. Gordon2, J. Petty3; 1Pulmonary and Critical Care Medicine, Parkview Medical Center, Pueblo, CO, United States, 2Pueblo Pulm Associates, Pueblo, CO, United States, 3Parkview Medical Center, Pueblo, CO, United States.
Introduction:
Pneumatoceles, also known as posttraumatic pulmonary pseudocyts, are cystic parenchymal lung lesions that are the result of pulmonary injury. They are most often associated with lung cancer, tuberculosis, lung abscess related to Hyper IgE syndrome (Job’s syndrome), and Staphylococcus aureus pneumonia. Management usually involves supportive care and observation. In cases of infection or patient intolerance, antibiotics, catheter drainage, and surgical resection may be required.
Case Report:
We present a 56 year old white female with a past medical history most significant for chronic respiratory failure on 3 liters of oxygen at home, prior tobacco use, COPD, and previously treated left sided empyema. The patient had presented from an outside facility roughly 2 ½ years prior for definitive treatment of her empyema following chest tube placement. Staphylococcal infection was presumed based on sputum gram stain. The patient required surgical decortication via a VATS that required conversion to an open thoracotomy with prolonged and extensive removal of the rind, which was noted to be up to 1cm thick in some places. The patient had a complicated recovery but was eventually discharged home. She returned to our facility for a presumed right lower lobe pneumothorax seen on CT. The patient noted sudden, severe right lower chest/right upper quadrant pain during intercourse (the first time since her surgery over 2 years ago) roughly one week prior to presentation. She described feeling a “pop” with the pain and described its character as being similar to that of a prior “kidney infection”. Over the next week she reported progressively worsening pain and “small pops” with inspiration and developed hemoptysis three days prior to presentation. The patient’s symptoms became intolerable and she required VATS for resection of the pneumatocele.
Discussion:
Pneumatoceles are most often associated with children and tend to occur infrequently in adults. Frequently they are associated with pneumonia, Staphylococcus being a common organism. Large pneumatoceles are thought to result from the development of a “one way valve” following necrosis and rupture of the bronchiolar wall. To our knowledge this is the first reported case of pneumatocele development following intercourse.
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