Pulmonary contusion: Difference between revisions

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==Background==
==Background==
*Direct damage to lung causing alveolar hemorrhage, edema, and debris accumulation
*Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
*Flail chest almost always associated with contusion
   
   
==Diagnosis==
==Clinical Features==
*Signs/symptoms
*[[Dyspnea]]
**SOB
*Tachypnea
**Tachypnea
*[[Chest pain]]
**Cyanosis
*Coarse breath sounds
**Hypotension
*[[Hypoxia]]
**Rales
*Widened A-a gradient
**Hypoxia
**Wide a-A


==Imaging==
 
*CXR
==Differential Diagnosis==
{{Thoracic trauma DDX}}
 
{{Pulmonary edema types}}
 
==Evaluation==
[[File:Pulmonary contusion.jpg |thumb|[[CXR]] showing right-sided pulmonary contusion, associated with [[rib fractures]] and [[subcutaneous emphysema]].]]
[[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
*[[CXR]]
**Patchy irregular infiltrates
**Patchy irregular infiltrates
**Always seen by 4-6 hr, always worse than what the 1st CXR shows
*CT
***Do not treat the CXR, treat the patient
**Ground-glass opacities in mild-moderate contusions, widespread consolidation if severe
**Flail chest almost always associated with contusion
**May pick up 70% of contusions not seen on CXR
**Contusion >20% of lung volume associated with 80% risk of developing ARDS


==Treatment==
==Management==
*If need to intubate: low tidal volume, high PEEP
*Ensure adequate ventilation
**[[Analgesia]]
**Ventilatory Assistance
***Patients with >25% of lung involvement frequently require ventilatory assistance
***[[NIPPV|NIV]] may be tried
***[[Intubate]] if NIV fails
****Low tidal volume, high PEEP
*Avoid unnecessary fluid administration


==Disposition==
==See Also==




==Source==
==See Also==
*Trauma Reports 4/04
*[[Rib Fracture]]
*[[Traumatic Pneumothorax]]


==References==
<references/>


[[Category:Pulmonary]]
[[Category:Trauma]]
[[Category:Trauma]]

Latest revision as of 13:29, 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


Differential Diagnosis

Thoracic Trauma

Pulmonary Edema Types

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

Evaluation

CXR showing right-sided pulmonary contusion, associated with rib fractures and subcutaneous emphysema.
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
    • 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.