Skip to Main Content

+

  • • 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

++

Epidemiology

+

  • • 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

++

Symptoms and Signs

+

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

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

++

Laboratory Findings

+

  • • Hypoxemia

++

Imaging Findings

+

  • • 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

+

  • • 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

+

  • • Physical exam

    • Chest x-ray

    • ABG measurements

+

  • • 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

++

Treatment Monitoring

+

  • • Serial ABG measurements

    • Serial chest films

++

Complications

+

  • • Pneumonia

    • Acute respiratory distress syndrome

++

Prognosis

+

  • • Pulmonary contusion has 15% overall mortality

++

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]

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.