Pulmonary contusion: Difference between revisions

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==Background==
==Background==
*Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
*Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
*Flail chest almost always associated w/ contusion
*Flail chest almost always associated with contusion
   
   
==Clinical Features==
==Clinical Features==
*Signs/symptoms
*[[Dyspnea]]
**Dyspnea
*Tachypnea
**Tachypnea
*[[Chest pain]]
**Chest pain
*Coarse breath sounds
**Coarse breath sounds
*[[Hypoxia]]
**Hypoxia
*Widened A-a gradient
**Widened A-a gradient


==Diagnosis==
===Imaging===
*Areas of lung opacification on chest imaging w/in 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 a/w 80% risk of developing ARDS


==Differential Diagnosis==
==Differential Diagnosis==
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{{Pulmonary edema types}}
{{Pulmonary edema types}}
==Evaluation==
*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==
==Management==
*Ensure adequate ventilation
*Ensure adequate ventilation
**Analgesia
**[[Analgesia]]
**Ventilatory Assistance
**Ventilatory Assistance
***Patients w/ >25% of lung involvement frequently require ventilatory assistance
***Patients with >25% of lung involvement frequently require ventilatory assistance
***NIV may be tried
***[[NIPPV|NIV]] may be tried
***Intubate if NIV fails
***[[Intubate]] if NIV fails
****Low tidal volume, high PEEP
****Low tidal volume, high PEEP
*Avoid unnecessary fluid administration
*Avoid unnecessary fluid administration
 
==Disposition==
 
 
==See Also==
==See Also==
*[[Rib Fracture]]
*[[Rib Fracture]]

Revision as of 14:34, 13 October 2019

Background

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

Clinical Features


Differential Diagnosis

Thoracic Trauma

Pulmonary Edema Types

Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[1]

Evaluation

  • 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
    • 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

Disposition

See Also

References

  1. Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.