Mystery Diagnosis: The Answer

A young male suffered blunt torso trauma when struck by a car. Many of you sent your guesses for what is shown in the image below:

This patient sustained a traumatic pneumatocele. It is an uncommon injury in blunt trauma, and can also be caused by penetrating injury. It’s essentially a complicated laceration that fills with air leaking from torn airways (alveoli or bronchi of various sizes). 

There is usually some focal hemorrhage around the injury, which looks (and is) a pulmonary contusion. The hallmark is the bubble (or bubbles) of air that form in the area of the injury. Frequently, these can be seen on chest xray as well, although CT is much more sensitive. They are more commonly located near the pleural surface of the lung in blunt trauma, because this is the area of maximum impact. When present, they are often situated very close to a rib fracture.

Generally, these injuries do not require any specific management. They slowly heal over time, but it may take months for them to completely resolve.

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