Beyond the Usual Course: A Rare Case of Persistent Traumatic Pulmonary Pneumatoceles With 8-Year Favorable Evolution

BACKGROUND Traumatic pulmonary pneumatoceles (TPP) are rare sequelae of chest trauma, most commonly observed in children due to their compliant chest wall. While typically self-limiting and resolving within weeks to months, large or long-term persistent lesions can pose diagnostic and therapeutic challenges. CASE REPORT We present the case of a 1-year-old boy who sustained severe head and blunt thoracic trauma following a high-impact motor vehicle accident. Chest computed tomography revealed 2 large right-sided pulmonary pneumatoceles, measuring up to 52 mm, associated with pulmonary contusions and a small pneumothorax. In accordance with a collegial agreement between the various medical specialties and with parental involvement and consent, a conservative management strategy was adopted, including mechanical ventilation and close monitoring without chest tube placement. Over an extended follow-up period of 8 years 5 months, one lesion resolved completely, while the other evolved into a stable, thin-walled cavity. The patient remained asymptomatic throughout, with no respiratory complications or functional limitations. CONCLUSIONS This case, featuring one of the longest documented radiological follow-ups, demonstrates that large pediatric TPPs can persist for years without clinical or functional impairment. Our findings suggest that lesion size alone should not mandate invasive intervention; rather, for asymptomatic patients, conservative management with vigilant surveillance is a safe and effective alternative to surgery.