Pulmonary contusion

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  • Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
  • Flail chest almost always associated with contusion

Clinical Features

  • Signs/symptoms
    • Dyspnea
    • Tachypnea
    • Chest pain
    • Coarse breath sounds
    • Hypoxia
    • Widened A-a gradient



  • Areas of lung opacification on chest imaging within 6hr of blunt trauma is diagnostic
  • CXR
    • Patchy irregular infiltrates
  • CT
    • Ground-glass opacities in mild-moderate contusions, widespread consolidation if severe
    • May pick up 70% of contusions not seen on CXR
    • Contusion >20% of lung volume associated with 80% risk of developing ARDS

Differential Diagnosis

Thoracic Trauma

Pulmonary Edema Types

Cardiogenic pulmonary edema

Noncardiogenic pulmonary edema


  • Ensure adequate ventilation
    • Analgesia
    • Ventilatory Assistance
      • Patients with >25% of lung involvement frequently require ventilatory assistance
      • NIV may be tried
      • Intubate if NIV fails
        • Low tidal volume, high PEEP
  • Avoid unnecessary fluid administration

See Also