Pulmonary contusion is trauma-induced lung hemorrhage and edema without laceration. Symptoms and signs are chest pain, dyspnea, and hypoxia that worsens over time. Diagnosis is by chest radiograph or CT. Treatment is with analgesics and supplemental oxygen; mechanical ventilation is sometimes required.
Pulmonary contusion is a common and potentially lethal chest injury that results from significant blunt or penetrating chest trauma. Patients may have associated rib fracture, sternal fracture, pneumothorax, or other chest injuries. Larger contusions can impair oxygenation. Late complications include pneumonia and sometimes acute respiratory distress syndrome (ARDS).
Symptoms of pulmonary contusion include chest pain (mainly due to injury to the overlying chest wall) and sometimes dyspnea. The chest wall is tender; other physical findings are those of any associated injuries.
Diagnosis of Pulmonary Contusion
Imaging, typically chest radiograph and CT
Pulmonary contusion should be suspected when respiratory distress develops after chest trauma, particularly when symptoms worsen gradually.
Chest radiography is typically performed. Contusions cause opacification of affected lung tissue on imaging, but opacification may not be apparent for 24 to 48 hours because opacification increases with time. CT is highly sensitive and is usually recommended to assess for pulmonary contusion in addition to concurrent injuries (1).
This chest radiograph shows pulmonary contusion with typical findings of patchy, nonsegmental air-space opacities in the left mid-to-lower lung. Hemothorax and an implantable cardioverter-defibrillator (ICD) are also present.
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Patients should be monitored for respiratory failure with serial clinical assessments and pulse oximetry. If hypoxemia or dyspnea is noted, capnometry or arterial blood gas measurement is indicated.
Diagnosis reference
1. Expert Panel on Major Trauma Imaging, Shyu JY, Khurana B, et al. ACR Appropriateness Criteria® Major Blunt Trauma. J Am Coll Radiol. 2020;17(5S):S160-S174. doi:10.1016/j.jacr.2020.01.024
Treatment of Pulmonary Contusion
Supportive care with analgesics and oxygen
Sometimes mechanical ventilation
Analgesics are given as needed to facilitate deep respirations in patients with pulmonary contusions. Supplemental oxygen (O2) is administered for mild hypoxemia (eg, SaO2 91 to 94%). Usual indications for mechanical ventilation are moderate or severe hypoxemia (usually PaO2 < 65 or SaO2 < 90% while breathing room air) and hypercarbia. Patients with chronic obstructive pulmonary disease (COPD) or chronic kidney disease are at increased risk of the need for mechanical ventilation.
