Pulmonary contusion: Difference between revisions
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*Flail chest almost always associated w/ contusion | *Flail chest almost always associated w/ contusion | ||
== | ==Clinical Presentation== | ||
*Signs/symptoms | *Signs/symptoms | ||
**Dyspnea | **Dyspnea | ||
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**Widened A-a gradient | **Widened A-a gradient | ||
==Imaging== | ==Diagnosis== | ||
===Imaging=== | |||
*Areas of lung opacification on chest imaging w/in 6hr of blunt trauma is diagnostic | *Areas of lung opacification on chest imaging w/in 6hr of blunt trauma is diagnostic | ||
*CXR | *CXR | ||
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**May pick up 70% of contusions not seen on CXR | **May pick up 70% of contusions not seen on CXR | ||
**Contusion >20% of lung volume a/w 80% risk of developing ARDS | **Contusion >20% of lung volume a/w 80% risk of developing ARDS | ||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
==Treatment== | ==Treatment== | ||
Revision as of 21:28, 6 December 2014
Background
- Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
- Flail chest almost always associated w/ contusion
Clinical Presentation
- Signs/symptoms
- Dyspnea
- Tachypnea
- Chest pain
- Coarse breath sounds
- Hypoxia
- 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
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Treatment
- Ensure adequate ventilation
- Analgesia
- Ventilatory Assistance
- Pts w/ >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
Source
- Tintinalli