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  • • Pulmonary contusion is due to sudden parenchymal concussion and occurs after blunt trauma or wounding with a high-velocity missile

    • Most lung lacerations are caused by penetrating injuries and hemopneumothorax is usually present

    • Lung hematomas are the result of local parenchymal destruction and hemorrhage

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Epidemiology

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  • • Pulmonary contusion occurs in 75% of patients with flail chest but can occur without associated rib fracture

    • 35% of patients with pulmonary contusion have an associated myocardial contusion

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Symptoms and Signs

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  • • Pulmonary contusion: Thin, blood-tinged secretions, chest pain, restlessness, apprehensiveness, and labored respirations

    • Eventually, dyspnea, cyanosis, tachypnea, and tachycardia develop

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Laboratory Findings

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  • • Hypoxemia

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Imaging Findings

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  • • Chest film findings of pulmonary contusion include patchy parenchymal opacification or diffuse linear peribronchial densities; overlying evidence of chest trauma including skeletal injuries

    • Lung hematoma: Initially a poorly defined density that becomes more circumscribed a few days to 2 weeks after injury

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  • • Treatment of pulmonary contusion is often delayed because clinical and radiologic findings may not appear for 12-48 hours after injury

    • Associated abdominal injuries may dictate course of care

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  • • Physical exam

    • Chest x-ray

    • ABG measurements

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  • • Initial resuscitation and stabilization

    • Pulmonary contusion: Supplemental oxygen, intubation and mechanical ventilation, avoid excessive hydration

    • Pulmonary laceration: Tube thoracostomy; most do not need surgery

    • Pulmonary hematoma: Expectant management is usually adequate

    • Supplemental oxygen

    • Intubation and mechanical ventilation if necessary for ventilatory support

    • Fluid resuscitation

    • Chest wall splinting

    • Analgesia

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Treatment Monitoring

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  • • Serial ABG measurements

    • Serial chest films

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Complications

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  • • Pneumonia

    • Acute respiratory distress syndrome

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Prognosis

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  • • Pulmonary contusion has 15% overall mortality

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References

Bergeron E et al: Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma 2003;54:478.  [PubMed: 12634526]
Cothren C et al: Lung-sparing techniques are associated with improved outcome compared with anatomic resection for severe lung injuries. J Trauma 2002;53:483.  [PubMed: 12352485]
Dulchavsky SA et al: Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 2001;50:201.  [PubMed: 11242282]
Mayberry JC et al: Absorbable plates for rib fracture repair: preliminary experience. J Trauma 2003;55:835.  [PubMed: 14608152]
Meredith JW, Hoth JJ: Thoracic trauma: when and how to intervene. Surg Clin N Am 2007;87:95.  [PubMed: 17127125]
Miller PR et al: ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma 2001;51:223.  [PubMed: 11493778]
Richardson JD et al: Operative fixation of chest wall fractures and underused procedure? Am Surg 2007;73:591.  [PubMed: 17658097]

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