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Pulmonary contusion
From WikEM
Contents
Background
- 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
Evaluation
Imaging
- 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
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Pulmonary Edema Types
Cardiogenic pulmonary edema
Noncardiogenic pulmonary edema
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion edema
- Neurogenic causes
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
- Other
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
See Also
References
Authors
Jordan Swartz, Ross Donaldson, Neil Young, Claire, Daniel Ostermayer
