Cardiothoracic Surgery: Pulmonary Cystic Lesions

Definition

• Definition: Air-Filled, Thin-Walled Cystic Lesions of the Lung
• Cyst in the Lung is a Misnomer – Contains a Collection of Gas (Not Fluid)

Types

• Bleb: Pleural/Subpleural < 1-2 cm
  • *Some Now Discourage the Use & Consider Bleb a Subtype of Bullae
• Bulla: Pleural/Subpleural > 1-2 cm
• Pneumatocele: Within the Lung Parenchyma

Causes

• Pneumonia – Most Common
• Trauma/Burns
• Positive-Pressure Ventilation
• Hydrocarbon Inhalation

Presentation

• Most are ASx & Resolve Spontaneously Over Days-Weeks
• PTX – Due to Dissection Through the Pleural Membrane
  • *See Cardiothoracic Surgery: Spontaneous Pneumothorax (PTX)
• Cardiorespiratory Compromise – Due to Compression
• Sepsis – Due to Secondary Infection

Treatment

• General Tx: Directed at the Underlying Process
• Indications for Percutaneous Drainage:
  • Cardiorespiratory Compromise Due to Compression
  • Secondary Infection
• Indications for Surgery (Deroofing vs Resection):
  • Failure of Percutaneous Drainage
  • Persistent Air Leak or PTX
  • Failure of Lung Expansion Despite Thoracostomy Tube
  • Massive Hemoptysis
• Spontaneous Pneumothorax:
  • *See Cardiothoracic Surgery: Spontaneous Pneumothorax (PTX)