Pulmonary contusion: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:Pulmonary contusion CT arrow.jpg|thumb|Chest CT showing a pulmonary contusion (red arrow) accompanied by [[rib fracture]] (blue arrow).]] | |||
*Areas of lung opacification on chest imaging within 6hr of blunt trauma is diagnostic | *Areas of lung opacification on chest imaging within 6hr of blunt trauma is diagnostic | ||
*[[CXR]] | *[[CXR]] | ||
Revision as of 13:28, 10 April 2021
Background
- Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
- Flail chest almost always associated with contusion
Clinical Features
- Dyspnea
- Tachypnea
- Chest pain
- Coarse breath sounds
- Hypoxia
- Widened A-a gradient
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Pulmonary Edema Types
Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[1]
- Cardiogenic pulmonary edema
- Noncardiogenic pulmonary edema
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion pulmonary edema
- Strangulation
- Neurogenic causes
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
- Other
- High altitude pulmonary edema
- Hypertensive emergency
- ARDS
- Flash pulmonary edema
- Immersion pulmonary edema
- Hantavirus pulmonary syndrome
- Missed dialysis in kidney failure
- Naloxone reversal
- Negative pressure pulmonary edema
Evaluation
Chest CT showing a pulmonary contusion (red arrow) accompanied by rib fracture (blue arrow).
- 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
Management
- Ensure adequate ventilation
- Avoid unnecessary fluid administration
Disposition
See Also
References
- ↑ Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.