Pulmonary contusion: Difference between revisions
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==Background== | ==Background== | ||
*Direct | *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 | ||
* | |||
== | |||
*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 | ||
** | *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 | |||
***[[NIPPV|NIV]] may be tried | |||
***[[Intubate]] if NIV fails | |||
****Low tidal volume, high PEEP | |||
*Avoid unnecessary fluid administration | |||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Rib Fracture]] | |||
*[[Traumatic Pneumothorax]] | |||
==References== | |||
<references/> | |||
[[Category:Pulmonary]] | |||
[[Category: | |||
[[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
- 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.