(See also Overview of Thoracic Trauma Overview of Thoracic Trauma Thoracic trauma causes about 25% of traumatic deaths in the US. Many chest injuries cause death during the first minutes or hours after trauma; they can frequently be treated at the bedside... read more .)
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 Rib Fracture One or more ribs can be fractured due to blunt chest injury. (See also Overview of Thoracic Trauma.) This x-ray of the chest shows multiple fractures to the right ribs (seen on left). Typically... read more , pneumothorax Pneumothorax (Open) Open pneumothorax is a pneumothorax involving an unsealed opening in the chest wall; when the opening is sufficiently large, respiratory mechanics are impaired. (See also Overview of Thoracic... read more , or other chest injuries. Larger contusions can impair oxygenation. Late complications include pneumonia and sometimes acute respiratory distress syndrome Acute Hypoxemic Respiratory Failure (AHRF, ARDS) Acute hypoxemic respiratory failure is severe arterial hypoxemia that is refractory to supplemental oxygen. It is caused by intrapulmonary shunting of blood resulting from airspace filling or... read more (ARDS).
Symptoms of pulmonary contusion include 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 x-ray
Pulmonary contusion should be suspected when respiratory distress develops after chest trauma, particularly when symptoms worsen gradually. Chest x-ray is typically done, along with pulse oximetry. 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 but is usually done only when other injuries are also under consideration.
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.
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 given for mild hypoxemia (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) Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is airflow limitation caused by an inflammatory response to inhaled toxins, often cigarette smoke. Alpha-1 antitrypsin deficiency and various occupational... read more or chronic kidney disease Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia... read more are at increased risk of the need for mechanical ventilation Overview of Mechanical Ventilation Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding... read more .