Eur J Cardiothorac Surg 2003;23:1076-1077
© 2003 Elsevier Science NL
Reply to Protopapas and Riga
Kalliopi Athanassiadi*,
M. Gerazounis
Department of Thoracic Surgery, General Hospital of Nikea, Piraeus, Hellas, Greece
Received 3 March 2003;
accepted 5 March 2003.
* Corresponding author. 34A, Konstantinoupoleos str., 15562 Holargos, Athens, Greece. Tel.: +30-210-6510388; fax: +30-210-6547695
e-mail: kallatha{at}otenet.gr
Key Words: Pulmonary traumatic pseudocysts • Tuberculosis • Blunt thoracic trauma • Cavitating lesions
We would like to thank Drs Protopapas and Riga for their comments on our article about traumatic pseudocysts. In our opinion, there is no possibility of confusing traumatic pseudocysts with tuberculous (TB) cavities. One should take the following points into account:
- History of patients: it clears out the existence of tuberculosis. As you well know, there is no case where a patient has a TB cavitating lesion without previous symptoms.
- Age of patients: patients with traumatic pseudocysts are quite young [1,2]. We do not anymore observe TB cavities in young patients suffering from TB [3], since the disease today has different characteristics other than the ones 30 years ago.
- Timing of appearance of traumatic pseudocyst: in the majority of cases described in the literature, these are detectable on chest X-ray or computed tomography (CT) scan only a few days after the accident [2,3], while the TB cavities should preexist on the first chest X-ray.
- The CT scan clearly defines the difference between traumatic pseudocysts and TB cavitary lesions. The presence of an air–fluid level and the consolidation of the surrounding lung due to the pulmonary contusion is an image not visible in TB cases [2,4]. The traumatic lesions are always in the middle and lower lobes or adjacent to the area of the pulmonary contusion [4,5] and they usually are lobulated [4], whereas other lesions including TB cavities would not necessarily be so positioned and are usually found apically. Additionally, in cases with TB, mediastinal lymphadenopathy is always present with apparent calcified lymph nodes and granulomatous tissue [2].
- Follow-up: the size, shape and nature of the wall of a traumatic cyst changes in a relatively short period unlike other kinds of cystic or cavitary lesions [4].
In conclusion, there are so many different characteristic points in these two entities that the differential diagnosis between them is easily evident.
References
- Sorsdahl O.A., Powell J.W. Cavitary pulmonary lesions following non-penetrating chest trauma in children. Am J Roentgenol 1965;95:118-124.[Abstract/Free Full Text]
- Athanassiadi K., Gerazounis M., Kalantzi N., Fakou A., Kourousis D. Primary traumatic pulmonary pseudocysts: a rare entity. Eur J Cardiothorac Surg 2003;23(1):43-45.[Abstract/Free Full Text]
- Cappabianca S., Barbieri A., Del Vecchio V., Sergi D., Grassi R. Recrudescence of pulmonary tuberculosis: radiological and CT features in an asymptomatic Southern Italian young population. Radiol Med (Torino) 2002;104(5–6):404-411.
- Kato R., Horonouchi H., Maenaka Y. Traumatic pulmonary pseudocyst: report of 12 cases. J Thorac Cardiovasc Surg 1989;97:309-312.[Abstract]
- Moore F.A., Moore E.E., Haenel J.B., Waring B.J., Parsons P.E. Post-traumatic pulmonary pseudocyst in the adult: pathophysiology, recognition, and selective management. J Trauma 1989;29(10):1380-1385.[Medline]
