Pulmonary contusion
Updates to Article Attributes
A pulmonary contusion refers to an interstitial and/or alveolar lung injury without any frank laceration. It usually occurs secondary to non-penetrating trauma. There is a significant risk of ventilator associated pneumonia in venitlated trauma patient that have pulmonary contusions, which carries a high mortality (up to 50%) 6.
Epidemiology
Contusions follow blunt or penetrating chest trauma, are are almost always seen with other chest (and abdominal) injuries. While contusion can affect anyone, children are considered more susceptible due to chest wall greater pliability in that age group, especially to pulmonary laceration.
Radiographic features
In most cases the findings are manifest at the time of the initial examination and show little tendency to increase in severity with subsequent examinations. Radiographic clearing of pulmonary contusion is relatively rapid, and the signs of contusion have often resolved within 48 hours. Features By day 10 they should have resolved completely 3. If the consolidation progresses after a day or two after the traumatic injury, then superimposed aspiration, atelectasis and infection should be considered.
Location
Features are often not localised in a a lobar or segmental pattern. Contusions usually occur adjacent to bony structures (as fractures cause the contusions), and are hence seem to be peripherally located 5.
Plain film
Not sensitiveInitial trauma CXR may be normal. Faint patchy consolidative regionsOver the first day following history of blunt traumatrauma, ill-defined geographic consolidation develop which are not sensitive for contusion, with differentials including aspiration, atelectasis and infection. Usually
Consolidation may be faint and usually shows rapid improvement with time, usuallycommonly over several days as the blood in the alveolar spaces is absorbed.
CT
Typically seen as focal, non segmental (typically crescentic) areas of parenchymal opacification, usually peripheral. Can have sub-pleuralsubpleural sparing with smaller contusions which can be a distinguishing feature. CommonerMore common posteriorly and in lower lobes.
Differential diagnosis
General imaging differential considerations include
See also
-<p>A <strong>pulmonary contusion</strong> refers to an interstitial and/or alveolar lung injury without any frank <a href="/articles/pulmonary-laceration-1">laceration</a>. It usually occurs secondary to non-penetrating trauma.</p><h4>Epidemiology</h4><p>While contusion can affect anyone, children are considered more susceptible due to chest wall greater pliability in that age group.</p><h4>Radiographic features</h4><p>In most cases the findings are manifest at the time of the initial examination and show little tendency to increase in severity with subsequent examinations. Radiographic clearing of pulmonary contusion is relatively rapid, and the signs of contusion have often resolved within 48 hours. Features are often not localised in a lobar or segmental pattern.</p><h5>Plain film</h5><p>Not sensitive. Faint patchy consolidative regions following history of blunt trauma. Usually shows rapid improvement with time, usually days.</p><h5>CT</h5><p>Typically seen as focal, non segmental (typically crescentic) areas of parenchymal opacification. Can have sub-pleural sparing with smaller contusions which can be a distinguishing feature. Commoner posteriorly and in lower lobes.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include</p><ul>- +<p>A <strong>pulmonary contusion</strong> refers to an interstitial and/or alveolar lung injury without any frank <a href="/articles/pulmonary-laceration-1">laceration</a>. It usually occurs secondary to non-penetrating trauma. There is a significant risk of ventilator associated pneumonia in venitlated trauma patient that have pulmonary contusions, which carries a high mortality (up to 50%) <sup>6</sup>.</p><h4>Epidemiology</h4><p>Contusions follow blunt or penetrating chest trauma, are are almost always seen with other chest (and abdominal) injuries. While contusion can affect anyone, children are considered more susceptible due to chest wall greater pliability in that age group, especially to pulmonary laceration.</p><h4>Radiographic features</h4><p>In most cases the findings are manifest at the time of the initial examination and show little tendency to increase in severity with subsequent examinations. Radiographic clearing of pulmonary contusion is relatively rapid, and the signs of contusion have often resolved within 48 hours. By day 10 they should have resolved completely <sup>3</sup>. If the consolidation progresses after a day or two after the traumatic injury, then superimposed aspiration, atelectasis and infection should be considered.</p><h5>Location</h5><p>Features are often not localised in a lobar or segmental pattern. Contusions usually occur adjacent to bony structures (as fractures cause the contusions), and are hence seem to be peripherally located <sup>5</sup>.</p><h5>Plain film</h5><p>Initial trauma CXR may be normal. Over the first day following trauma, ill-defined geographic consolidation develop which are not sensitive for contusion, with differentials including aspiration, atelectasis and infection.</p><p>Consolidation may be faint and usually shows rapid improvement with time, commonly over several days as the blood in the alveolar spaces is absorbed.</p><h5>CT</h5><p>Typically seen as focal, non segmental (typically crescentic) areas of parenchymal opacification, usually peripheral. Can have subpleural sparing with smaller contusions which can be a distinguishing feature. More common posteriorly and in lower lobes.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include</p><ul>
- +<li><a title="pneumonia" href="/articles/pneumonia">pneumonia</a></li>
- +<li><a title="Fat embolism to lungs" href="/articles/pulmonary-fat-embolism">fat embolism</a></li>
References changed:
- 5. Ho ML, Gutierrez FR. Chest radiography in thoracic polytrauma. AJR Am J Roentgenol. 2009;192 (3): 599-612. <a href="http://www.ajronline.org/content/192/3/599.full">AJR Am J Roentgenol (full text)</a> - <a href="http://dx.doi.org/10.2214/AJR.07.3324">doi:10.2214/AJR.07.3324</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19234253">Pubmed citation</a><span class="ref_v3"></span>
- 6. Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin. Microbiol. Rev. 2006;19 (4): 637-57. <a href="http://dx.doi.org/10.1128/CMR.00051-05">doi:10.1128/CMR.00051-05</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592694">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17041138">Pubmed citation</a><span class="auto"></span>
Systems changed:
- Trauma
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