HWN Suggests

Pediatric Pulmonary Contusion

Certainly the #1 cause of death after blunt trauma in pediatric patients is Head Injury… but did you know that #2 was Thoracic Injury? And the most common intra-thoracic injury in kids is Pulmonary Contusion.

The pediatric chest wall is very compliant… Which is good, because ribs don’t often fracture… But it is also bad, because it doesn’t dissipate force, which leads to more of the impact force being directly applied to the lung tissue. This force can cause blood to fill the alveoli (Pulmonary Contusion) and that can lead to V/Q mismatch, which in turn leads to hypoxia.

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 Pulmonary Contusion on Admission Chest X-ray is Associated with Coagulopathy and Mortality in Trauma Patients

The major impetus for conducting this study was the observation of several patients presenting with an isolated pulmonary contusion, profound hypoxia and significant coagulopathy. While the literature is extensive on both pathologies, there is little regarding a relationship between them.

Articles of Interest

Blast Lung Injury

The blast wave’s impact upon the lung results in tearing, hemorrhage, contusion, and edema with resultant ventilation-perfusion mismatch. BLI is a clinical diagnosis and is characterized by respiratory difficulty and hypoxia, which may occur without obvious external injury to the chest.

Blush in Lung Contusions Is Not Rare and Has a High Risk of Mortality in Patients With Blunt Chest Trauma

Our study revealed that blush in lung contusions was not rare and was associated with a high risk of mortality in patients with severe blunt chest trauma. Clinicians should not hesitate to intervene if blush is detected in a lung contusion of a patient with blunt chest trauma.

Pulmonary Contusion

Primarily supportive. Watch for delayed presentation!. Consider Bipap; pain control with intercostal block or epidural inpatient. Avoid unnecessary fluids.

Pulmonary Contusion and Flail Chest

Pulmonary contusion and flail chest are the two most common anatomic complications of major blunt chest trauma. Each will directly alter pulmonary physiology in a specific and unique fashion, and thus contribute to pulmonary dysfunction and failure after trauma. Pulmonary contusion was probably first described by Morgagni in the 18th century, but Laurent’s description in the Lancet in 18831 appears to be the first to recognize the possibility that plasticity of the chest wall, most notably in the young, can allow injury to the underlying lungs without disruption of the bony thorax.

Pulmonary Contusion and Flail Chest, Management of

Before the 20th century, the entity of PC had rarely been described, and its clinical significance was not recognized. During World War I, significant numbers of battlefield dead were noted to be without external signs of trauma and postmortem studies revealed lung hemorrhage.[31–33] Subsequently, the critical study during this conflict identified PC as the major clinically significant effect of concussive force.

Pulmonary Contusion: An Update on Recent Advances in Clinical Management

Pulmonary contusion is a common finding after blunt chest trauma. The physiologic consequences of alveolar hemorrhage and pulmonary parenchymal destruction typically manifest themselves within hours of injury and usually resolve within approximately 7 days.

The Chest Bump: Pulmonary Pearls & Pitfalls to Consider in Patients with Chest Trauma

Good Lung Down”: mechanically ventilated patients are more susceptible to lung contusions, however improvements in ventilation-perfusion matching can be made by turning the patient in the lateral decubitus position so that the non-injured lung is now dependent or downwards pointing to the floor.

Resources

Radiology Key

Contusions are a risk factor for development of pneumonia or acute respiratory distress syndrome. Patients with contusions seen only on the CT image and not on the chest radiograph may have a prognosis similar to those that do not have pulmonary contusions at all on CT (i.e., “CT-only” contusion may have a better outcome than contusions that are visible on both CT and chest x-ray examination). Pulmonary contusion usually resolves in 1 to 14 days. Generally, if the chest radiograph or CT has not cleared by day 14, alternate diagnoses such as development of pneumonia, acute respiratory distress syndrome, or aspiration should be considered.

StatPearls

A pulmonary contusion is an injury to the lung parenchyma in the absence of laceration to lung tissue or any vascular structures. It usually results from blunt chest trauma, shock waves associated with penetrating chest injury, or explosion injuries.

WikEM

Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration. Flail chest almost always associated with contusion.