II. Epidemiology

  1. Pulmonary Contusion is the most common potentially lethal Chest Injury

III. Risk Factors: Increased Morbidity

V. 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

VII. 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

VIII. 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

IX. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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Related Studies

Ontology: Contusion of chest (C0160925)

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, キョウヘキノザショウ, ムネノザショウ
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, ハイザショウ
Portuguese Contusão pulmonar
Spanish Contusión pulmonar, contusión de pulmón, contusión pulmonar (trastorno), contusión pulmonar