AJTCCM VOL. 29 NO. 2 2023 81
PICK OF THE PICS
A 28-year-old male, known intravenous
drug user, presented with a four-day
history of productive cough and fever.
Inspiratory crackles were heard throughout
both lung fields. Cardiac examination
revealed a tricuspid regurgitation murmur.
Methicillin-sensitive Staphylococcus aureus
was cultured from blood on three separate
occasions. Transthoracic echocardiogram
conrmed moderate tricuspid regurgitation.
Chest radiograph revealed bilateral
pneumatoceles, many in evolution with
surrounding consolidation.[1] Pneumatoceles
are thin-walled, air-lled cysts in the lung
parenchyma.[2,3] e likely pathogenesis is
necrosis of lung parenchyma, allowing one-
way air-ow into the interstitial space.[2,3].
Infection is a common cause, most often
Staphylococcus aureus. It has been reported
that a high portion of Staphylococcus
aureus infections resulted in pneumatocele
formation.[1,2] Other causes include trauma
and hydrocarbon aspiration.[2] The major
complications of pneumatoceles are
pneumothoraces and haemoptysis.[2,4] First-
line treatment in cases of infective aetiology
is antibiotics, and surgical intervention is
rarely needed.[2]
1. Flaherty RA, Keegan JM, Sturtevant HN. Post-
Pneumonic Pulmonary Pneumatoceles. Radiology
1960;74: 50-53.
2. Jamil A, Kasi A. Pneumatocele. StatsPearl Publishing:
Treasure Island, 2022. https://www.ncbi.nlm.nih.gov/
books/NBK556146/
3. Reed JC. Multiple Lucent Lesions. In: Chest Radiology:
Patterns and Dierential Diagnosis, 7th edn. Elsevier,
2019:361-385.
4. Natarajan P, Skidmore J, Aduroja O, Kunam V, Schuller
D. Bilateral pneumatoceles resulting in spontaneous
bilateral pneumothoraces and secondary infection
in a previously healthy man with COVID-19.
Baylor University Medical Center Proceedings,
2021;34(5):590-592.
What are the common causes of pneumatoceles?
G J Titus, MB ChB, FCP(SA); M L Wong, MB BCh, FCP(SA), FCCP, FRCP (Lond)
Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Figure 1: Chest Radiograph illustrating pneumatoceles
