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Pneumatocele Clinical Presentation

  • Author: Denise Serebrisky, MD; Chief Editor: Michael R Bye, MD  more...
 
Updated: Jan 31, 2016
 

History

Children present with typical features of pneumonia, including cough, fever, and respiratory distress. No clinical findings differentiate pneumonia with or without pneumatocele formation.

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Physical

Mild, moderate, or severe respiratory distress may be present, with tachypnea, retractions, grunting, and nasal flaring. Fever is almost always present and may be as high as 40-41°C.

Lung examination findings vary depending on the stage of the pneumonia. Auscultation of the chest reveals focal or bilateral decreased breath sounds. Inspiratory crackles are frequently heard. As the pneumonia resolves and the pneumatocele persists, the lung examination findings can be normal or focal decreases in breath sounds can be present, depending on the size of the pneumatocele.

In most children admitted to the hospital, the average time from admission to the development of the pneumatocele is 4-7 days. Occasionally, pneumatoceles are present on the initial radiograph.

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Causes

Although no particular genetic predisposition is recognized, pneumatocele formation is associated with hyperimmunoglobulin E (IgE) syndrome (Buckley-Job syndrome).[11, 12] Because of immunodeficiency, individuals with this syndrome are predisposed to infection with staphylococcal pneumonia, with the known complications of abscess and pneumatocele formation.

Infectious etiologies associated with pneumatocele formation include the following:

  • S aureus
  • S pneumoniae
  • H influenzae
  • K pneumoniae
  • S marcescens
  • E coli
  • Group A streptococci
  • Mycobacterium tuberculosis
  • Pseudomonas aeruginosa
  • Adenovirus

Noninfectious etiologies include the following:

  • Trauma
  • Hydrocarbon ingestion
  • Positive pressure ventilation (especially among premature infants)[13]
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Contributor Information and Disclosures
Author

Denise Serebrisky, MD Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director, Division of Pulmonary Medicine, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center/North Central Bronx Hospital; Director, Jacobi Asthma and Allergy Center for Children, Jacobi Medical Center

Denise Serebrisky, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Arthur B Atlas, MD Assistant Clinical Professor, Department of Pediatrics, University of Medicine and Dentistry of New Jersey

Arthur B Atlas, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Sleep Medicine, American College of Chest Physicians, American Lung Association, American Thoracic Society, Medical Society of New Jersey

Disclosure: Received grant/research funds from astra zeneca for none.

Debra Boyer, MD Fellow, Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital of Boston

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

References
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Pneumonia with multiple pneumatoceles.
Pneumonia with pneumatocele (lateral).
Resolving pneumatocele.
Chest CT scan of pneumonia with pneumatocele.
 
 
 
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