[Subcutaneous fistula from a pneumatocele: surgical treatment]

A pneumatocele is an air containing cavity, without a wall. It is a rare complication of thoracic trauma.

The patient was a 46-year-old drug addict, positive for the human immunodeficiency virus. Following a fall in which he fractured the posterior parts of the right 7th and 8th ribs, he developed a subcutaneous fistula and a pneumatocele of the right lower lobe. It did not resolve spontaneously and surgery was undertaken. The pneumatocele and the subcutaneous cavity were drained and the rib fractures were stabilized with Judet struts.

Pneumatocele is a classical but rare complication of thoracic trauma, resulting from a tear of the lung. The differential diagnosis includes localised pneumothorax, an intrathoracic gastric hernia and pneumomediastinum. The usual treatment is surveillance but in this case, surgery was necessary for drainage of the cavities and stabilization of the rib fractures.