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Eur J Cardiothorac Surg 2003;23:1076
© 2003 Elsevier Science NL

Letter to the Editor

Cavitary pulmonary lesions noted after blunt thoracic trauma: causative relation or pre-existing tuberculosis?

Imperial College of Science, Technology and Medicine, Imperial College, London SW7 2AZ, UK

Received 23 January 2003; accepted 5 March 2003.

^* Corresponding author. 37, The Farthings, Kingston-upon-Thames, London KT2 7PT, UK. Tel.: +44-7956-897683; fax: +44-2085-462901
e-mail: aristotelis.protopapas{at}ic.ac.uk

Key Words: ATLs • Cavitation • CT scan • Thoracic trauma • Tuberculosis

You published a study on cavitary pulmonary lesions related to blunt thoracic trauma [1]. We congratulate the authors on presenting their 10-year experience with 12 cases of a rare, yet multi-faceted, clinical entity.

Our attention was drawn to Fig. 2, a ‘slice’ of computed tomography of a young victim of trauma. We noticed a striking similarity to images from tuberculous (TB) transient multiple cysts [2] and TB cavitation [3]. We note thence:

1. The fact that a period of days or weeks is required, regardless of the cause, for florid pulmonary cavitary or ‘cystic’ changes to become radiographically evident;
   
2. The short, as stated by the authors, time lapsed from trauma to imaging – commendable practice, of course!
   
3. The conservative treatment of all these patients that precluded pathological studies of the lesions in question;
   
4. The relatively high prevalence of TB in the young Greek population [4].
   

We, therefore, alert the readers of this Journal to the possible confusion of cavitating TB lesions with the so-called ‘traumatic’ pulmonary pseudocyst.

In the assessment of thoracic trauma, indolent pre-existing chronic pathology may lead to diagnostic and therapeutic pitfalls. As many surgeons know, trauma can always unmask other conditions....

References

1. Athanassiadi K., Gerazounis M., Kalantzi N., Kazakidis P., Fakou A., Kourousis D. Primary traumatic pulmonary pseudocysts: a rare entity. Eur J Cardiothorac Surg 2003;23(1):43-45.[Abstract/Free Full Text]
2. Lee J.Y., Lee K.S., Jung K.J., Han J., Kwon O.J., Kim J., Kim T.S. Pulmonary tuberculosis: CT and pathologic correlation. J Comput Assist Tomogr 2000;24(5):691-698.[CrossRef][Medline]
3. Aribandi M., Gulati M., Behera D., Das K.M., Chandra N.E., Suri S. Computed tomography features of lung parenchymal changes in pulmonary tuberculosis. Australas Radiol 1997;41(4):367-370.[Medline]
4. Bouros D., Demoiliopoulos J., Panagou P., Yiatromanolakis N., Moschos M., Paraskevopoulos A., Demoiliopoulos D., Siafakas N.M. Incidence of tuberculosis in Greek armed forces from 1965–1993. Respiration 1995;62(6):336-340.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Aristotle D. Protopapas Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Protopapas, A. D. Articles by Riga, A. T. Search for Related Content PubMed PubMed Citation Articles by Protopapas, A. D. Articles by Riga, A. T. Related Collections Lung - other