Tuberc Respir Dis.  2006 May;60(5):564-570.

A Case of Cavitary Lung Lesion as a Consequence of Smoke Inhalation Injury

• Shin HW
• Kim CH
• Eom KS
• Park YB
• Jang SH
• Kim DG
• Lee MG
• Hyun IG
• Jung KS
• Lee ES

Abstract

Toxic gases and soot deposition as a consequence of smoke inhalation can cause direct injury to the upper and lower airways and even to the lung parenchyma. A delay in proper and prompt therapy can be detrimental to critically ill burn patients with an inhalation injury. Therefore, serial chest radiography is an important diagnostic tool for pulmonary complications during treatment. The radiographic findings of the chest include normal, consolidation, interstitial and alveolar infiltrates, peribronchial thickening, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, and a pneumothorax as acute complications of smoke inhalation. In addition, bronchiectasis, bronchiolitis obliterans and pulmonary fibrosis can occur as late complications. We encountered a case of 44-year-old male who presented with acute lung injury after an inhalation injury. He required endotracheal intubation and mechanical ventilation due to respiratory failure. He was managed successfully with conservative treatment. Later, a cavitary lesion of the left upper lobe was observed on the chest radiography and computed tomography, which was complicated by massive hemoptysis during the follow-up. However, the cavitary lesion disappeared spontaneously without any clinical consequences.

Keyword

Inhalation; Burn; Radiography

MeSH Terms

Acute Lung Injury
Adult
Bronchiectasis
Bronchiolitis Obliterans
Burns
Critical Illness
Follow-Up Studies
Gases
Hemoptysis
Humans
Inhalation
Intubation, Intratracheal
Lung*
Male
Pneumothorax
Pulmonary Atelectasis
Pulmonary Edema
Pulmonary Fibrosis
Radiography
Respiration, Artificial
Respiratory Insufficiency
Smoke Inhalation Injury*
Smoke*
Soot
Thorax
Gases
Smoke
Soot

Figure

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  Figure 1 Chest radiography in 44-year-old man who had inhalation injury. A. Chest X-ray on admission showed alveolar and interstitial edema with normal cardiac size, distributed in both perihilar and both lower lung zones. B. One month later, chest X-ray showed improvement of interstitial edema and new cavitary lesion (arrow) in the left upper lung.

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  Figure 2 Changes of PaO2/FiO2 ratio from admission to extubation.

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  Figure 3 High resolution computed tomography (HRCT) at the trachea level in 44-year-old man who had inhalation injury. A. On post-inhalation injury 19th day, HRCT showed bilateral ground glass opacities and small cavitary nodular consolidation in the left upper lung. B. On post-inhalation injury 45th day, HRCT showed slight improvement of bilateral ground glass opacities and more increment of the cavitary lesion of the left upper lobe. C. On post-inhalation injury 76th day, the cavitary lesion of the left upper lobe was more increased and thin-walled. D. On post-inhalation injury 175th day, the cavitary lesion of the left upper lobe was completely disappeared.

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  Figure 4 A. On post-inhalation injury 75th day, bronchial artery embolization was performed due to massive hemoptysis. Left bronchial angiography showed hypervasular staining in upper and lower lobe of left lung B. On post-inhalation injury 175th day, bronchoscopy was performed due to minor hemoptysis. The bronchoscopy revealed small round polypoid lesion with congestion at the mid-trachea. The lesion was successfully removed by bronchoscopic excision (H & E, ×12).

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