Pulmonary Contusion

• • 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