Pulmonary contusion

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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

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

Differential Diagnosis

Thoracic Trauma

Pulmonary Edema Types

Cardiogenic pulmonary edema

Noncardiogenic pulmonary edema

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