Pulmonary contusion: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Dyspnea | *[[Dyspnea]] | ||
*Tachypnea | *Tachypnea | ||
*[[Chest pain]] | *[[Chest pain]] | ||
*Coarse breath sounds | *Coarse breath sounds | ||
*Hypoxia | *[[Hypoxia]] | ||
*Widened A-a gradient | *Widened A-a gradient | ||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
{{Pulmonary edema types}} | |||
==Evaluation== | ==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 | *Areas of lung opacification on chest imaging within 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 associated with 80% risk of developing ARDS | **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 with >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 | ||
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
- Dyspnea
- Tachypnea
- Chest pain
- Coarse breath sounds
- Hypoxia
- Widened A-a gradient
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Pulmonary Edema Types
Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[1]
- Cardiogenic pulmonary edema
- Noncardiogenic pulmonary edema
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion pulmonary edema
- Strangulation
- Neurogenic causes
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
- Other
- High altitude pulmonary edema
- Hypertensive emergency
- ARDS
- Flash pulmonary edema
- Immersion pulmonary edema
- Hantavirus pulmonary syndrome
- Missed dialysis in kidney failure
- Naloxone reversal
- Negative pressure pulmonary edema
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
- Avoid unnecessary fluid administration
Disposition
See Also
References
- ↑ Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.