A previously healthy 17-year-old male presented with the complaint of mild hemoptysis after sustaining a blunt trauma to the chest. He fell off a 3-foot cliff while hiking and landed on the right side of his chest. On presentation, the patient's pain was tolerable and he was breathing comfortably. His vital signs showed a pulse of 98 beats per minute, blood pressure of 110/60 mmHg, and an oxygen saturation of 98% on room air. His exam revealed minimal abrasions, ecchymosis, and tenderness over the right lower chest wall at the anterior axillary line. His lung exam revealed decreased breath sounds over the right lower lung field. A chest X-ray obtained within 2 hours of the trauma showed alveolar opacities in the right lower lobe with multiple cystic air spaces containing air-fluid levels (Figure 1). There were no associated pleural effusions, pneumothorax, or rib fractures. A Computed Tomography (CT) scan of the chest showed thick-walled multicystic lesions with patchy air space opacities and consolidations in the right lower lobe (Figure 2). No previous chest imaging was available for comparison. The described CT scan abnormalities, in the absence of extrapulmonary posttraumatic findings, were suggestive of CPAM with superimposed bleeding. The patient was admitted for observation and evaluation and placed on intravenous Amoxicillin/Clavulanate. Spirometry done the next day was normal. His complete blood count, basic metabolic panel and bleeding profile were normal. His C-reactive protein was elevated at 32.0 mg/L. Gram stain, acid fast stain, and sputum cultures for bacteria, fungi, and tuberculosis were all negative. Alpha-1 antitrypsin and immunoglobulin levels were within normal limits.
The patient was evaluated by a cardiothoracic surgeon and a right lower lobectomy was being considered. However, given the indolent course of his disease and his negative history for pulmonary infections thus far, the patient elected to defer further surgical evaluation and, instead, follow-up with clinical observation. He remained asymptomatic throughout the interval period and a chest X-ray repeated after one year was normal (Figure 3). Finally, a CT scan of the chest obtained two years later showed complete resolution of the previously described abnormalities (Figure 4). Due to the fact that his cysts resolved spontaneously with time after his trauma, the patient was finally diagnosed with TPP.