II. Epidemiology
- Pulmonary Contusion is the most common potentially lethal Chest Injury
III. Risk Factors: Increased Morbidity
IV. Causes
V. Pathophysiology
-
Traumatic Injury to chest results in Lung Contusion
- May occur without Rib Fracture
- Alverolar capillary damage occurs with Blunt Chest Trauma
- Alveolar space accumulation of blood and fluid with decreased lung compliace and lung injury
- Results in ventilation-Perfusion Mismatch (VQ Mismatch) and intrapulmonary shunting
- Slow, insidious Respiratory Failure with secondary Hypoxia
VI. Signs
VII. Imaging
-
Chest XRay
- Initially underwhelming compared to clinical status for first 6 hours
- Alveolar Infiltrates not limited to lobar boundaries (peak appearance at 48 hours after injury)
- CT Chest
- Defines region of lung injury
VIII. Indications: Management
- Early Endotracheal Intubation Indications despite Supplemental Oxygen
- Arterial Blood Gas with PaO2 <65 mmHg or
- Oxygen Saturation <90%
- Admit most patients (especially elderly)
- Respiratory distress peaks at 48-72 hours
- Respiratory status can deteriorate rapidly
- Discharge indications
- Young, healthy, stable and compliant patient AND
- Near normal Chest XRay AND
- Will perform incentive Spirometry at home frequently (every 1-2 hours) AND
- Has close, reliable follow-up scheduled
IX. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| ICD9 | 922.1 |
| SnomedCT | 157522006, 10050004 |
| English | Contusion of chest wall, Contusion, chest wall, Superfic bruising chest wall, Contusion of chest, Bruising of chest, contusion of chest (physical finding), contusion of chest, bruising chest, bruised chest, contusion chest wall, chest contusion, chest wall contusion, Superficial bruising of chest wall, Contusion of chest (disorder) |
| Dutch | blauwe plek op borst, borstkaskneuzing |
| French | Ecchymose de la poitrine, Contusion de la paroi thoracique |
| German | Prellung der Brustwand, blaue Flecken an der Brust |
| Italian | Contusione del torace, Contusione della parte toracica |
| Portuguese | Contusão da parede torácica, Contusão do tórax |
| Spanish | Cardenales en el pecho, Contusión de la pared torácica, contusión del tórax (trastorno), contusión del tórax |
| Japanese | 胸の挫傷, 胸壁の挫傷, ｷｮｳﾍｷﾉｻﾞｼｮｳ, ﾑﾈﾉｻﾞｼｮｳ |
| Czech | Kontuze hrudní stěny, Zhmoždění hrudníku |
| Hungarian | Véraláfutás a mellkason, A mellkasfal zúzódása |
Ontology: Contusion of lung (C0347625)
| Concepts | Injury or Poisoning (T037) |
| ICD10 | S27.329 , S27.32 |
| SnomedCT | 262784001 |
| English | contusion of lung, contusion of lung (diagnosis), Contusion of lung, unspecified, pulmonary contusion, lung contusion, contusion lungs, contusions lung, contusions pulmonary, Contusion pulmonary, Contusion of lung, Pulmonary contusion, Contusion of lung (disorder) |
| Czech | Plicní kontuze, Kontuze plicní |
| Dutch | longcontusie, longkneuzing |
| French | Contusion pulmonaire |
| German | pulmonale Kontusion, Lungenquetschung |
| Hungarian | Pulmonalis contusio, A tüdő zúzódása |
| Italian | Contusione del polmone |
| Japanese | 肺挫傷, ﾊｲｻﾞｼｮｳ |
| Portuguese | Contusão pulmonar |
| Spanish | Contusión pulmonar, contusión de pulmón, contusión pulmonar (trastorno), contusión pulmonar |
