Pulmonary contusion: Difference between revisions
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==Background== | ==Background== | ||
*Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration | *Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration | ||
*Flail chest almost always associated | *Flail chest almost always associated with contusion | ||
==Clinical | ==Clinical Features== | ||
* | *[[Dyspnea]] | ||
*Tachypnea | |||
*[[Chest pain]] | |||
* | *Coarse breath sounds | ||
*[[Hypoxia]] | |||
* | *Widened A-a gradient | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 26: | Line 16: | ||
{{Pulmonary edema types}} | {{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 | |||
*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== | ==Management== | ||
*Ensure adequate ventilation | *Ensure adequate ventilation | ||
**Analgesia | **[[Analgesia]] | ||
**Ventilatory Assistance | **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 | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Rib Fracture]] | *[[Rib Fracture]] | ||
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.