Pneumatocele Clinical Presentation

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

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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