Hindawi Publishing Corporation Case Reports in Pediatrics Volume 2013, Article ID 940189, 3 pages http://dx.doi.org/10.1155/2013/940189 Case Report Large Traumatic Pneumatocele in a 2-Year-Old Child N. K. Cheung, 1 A. James, 2 and R. Kumar 3 1 Department of Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia 2 Department of Cardiothoracic Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia 3 Department of Paediatric Surgery, John Hunter Children’s Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia Correspondence should be addressed to R. Kumar; rajendra.kumar@hnehealth.nsw.gov.au Received 3 August 2013; Accepted 22 August 2013 Academic Editors: Y. Z. Bai, S. Burjonrappa, S. G. Golombek, and Z. Jiang Copyright © 2013 N. K. Cheung et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Traumatic pneumatoceles are a rare complication of blunt chest trauma in children. Although they characteristically present as small, regular shaped lesions which can be safely treated nonoperatively, larger traumatic pneumatoceles pose diagnostic and management difculties for clinicians. Tis case study reports one of the largest traumatic pneumatoceles reported to date in the paediatric population, which resulted in aggressive surgical intervention for both diagnostic and treatment reasons. Tis case adds further evidence to the current literature that signifcantly large traumatic pneumatoceles with failure of initial conservative management warrant surgical exploration and management to optimise recovery and prevent complications. 1. Introduction Traumatic pneumatocele (TP) is a rare condition occurring afer blunt chest trauma in children and young adults, accounting for 3.9% of paediatric blunt chest traumas. In the literature, it has been described as traumatic pneumatoce- les, traumatic lung cysts, pulmonary cavitations, cavitating haematoma, and traumatic pulmonary pseudocysts [1–6]. TP is characterized by the appearance of pulmonary cavities with no epithelial lining flled with air, fuid or, blood seen on radiology imaging, which usually resolve without surgery. It is commonly associated with pulmonary contusions but represents more extensive tissue disruptions and severity of injuries than a simple contusion [2, 3]. Clinical presentations, ofen seen within the frst three to seven days afer injury, include chest pain, cough, haemoptysis and dyspnea, and rarely irritability and mental changes [2, 3]. Conservative treatment is recommended when TP can be correctly diag- nosed [2, 7], although dilemmas with their optimal manage- ment can arise with more complicated cases due to a paucity of paediatric case studies described in the literature. Tis report presents an unusual case of a very large traumatic pneumatocele resulting in surgical management to improve recovery time and to exclude serious underlying pathology and complications. 2. Case Presentation A 2-year-old boy presented to the emergency department afer being knocked over and his lef shoulder and chest trapped under the rear wheels of a reversing car. He was shocked on arrival and had bruising on the lef shoulder and chest, along with widespread petechiae across his face and eyes. Chest X-ray afer resuscitation revealed bilateral contusions (Figure 1). A chest tube was placed for a suspected lef pneumothorax. CT scan later demonstrated a massive and irregular traumatic pneumatocele extending throughout the lef lung with extensive bilateral pulmonary contusions (Figures 2 and 3). Te child’s clinical and respiratory status rapidly deteri- orated, with maximum fow oxygen barely maintaining his oxygen saturations over 90%. He was intubated and venti- lated; despite intensive support and conservative manage- ment over 24 hours, his clinical progress worsened. Tere was no radiographic improvement demonstrated, with concerns of a large haematocele or haemopneumothorax complicating the pneumatocele due to falling haemoglobin levels. Tere was additionally a concern of associated severe injuries, such as a ruptured hemidiaphragm, which could not be ruled out. Based on these fndings, an urgent lef thoracotomy was performed for exploration and for surgical repair.