Pulmonary Contusion


Pulmonary Contusion, Lung Contusion, Chest Contusion

  • Epidemiology
  1. Pulmonary Contusion is the most common potentially lethal Chest Injury
  • Pathophysiology
  1. Traumatic Injury to chest results in Lung Contusion
    1. May occur without Rib Fracture
  2. Alverolar capillary damage occurs with Blunt Chest Trauma
    1. Alveolar space accumulation of blood and fluid with decreased lung compliace and lung injury
    2. Results in ventilation-Perfusion Mismatch (VQ Mismatch) and intrapulmonary shunting
    3. Slow, insidious Respiratory Failure with secondary Hypoxia
  • Imaging
  1. Chest XRay
    1. Initially underwhelming compared to clinical status for first 6 hours
    2. Alveolar Infiltrates not limited to lobar boundaries (peak appearance at 48 hours after injury)
  2. CT Chest
    1. Defines region of lung injury
  • Indications
  • Management
  1. Early Endotracheal Intubation Indications despite Supplemental Oxygen
    1. Arterial Blood Gas with PaO2 <65 mmHg or
    2. Oxygen Saturation <90%
  2. Admit most patients (especially elderly)
    1. Respiratory distress peaks at 48-72 hours
    2. Respiratory status can deteriorate rapidly
  3. Discharge indications
    1. Young, healthy, stable and compliant patient AND
    2. Near normal Chest XRay AND
    3. Will perform incentive Spirometry at home frequently (every 1-2 hours) AND
    4. Has close, reliable follow-up scheduled
  • References
  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21