Pulmonary Contusion: an Update on Recent Advances in Clinical Management

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2010 Apr 22

PMID 20407767

Citations 46

Authors

Stephen M Cohn

Joseph J Dubose

Affiliations

Soon will be listed here.

Abstract

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. Clinical symptoms, including respiratory distress with hypoxemia and hypercarbia, peak at about 72 h after injury. The timely diagnosis of pulmonary contusion requires a high degree of clinical suspicion when a patient presents with trauma caused by an appropriate mechanism of injury. The clinical diagnosis of acute parenchymal lung injury is usually confirmed by thoracic computed tomography, which is both highly sensitive in identifying pulmonary contusion and highly predictive of the need for subsequent mechanical ventilation. Management of pulmonary contusion is primarily supportive. Associated complications such as pneumonia, acute respiratory distress syndrome, and long-term pulmonary disability, however, are frequent sequelae of these injuries.

Citing Articles

The pulmonary contusion score: Development of a simple scoring system for blunt lung injury.

Toelle L, McNickle A, Feery D, Mohammed S, Chestovich P, Batra K Surg Pract Sci. 2025; 17():100247.

PMID: 39845634 PMC: 11749804. DOI: 10.1016/j.sipas.2024.100247.

Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT.

Kaatsch H, Vollmecke M, Becker B, Dillinger D, Kubitscheck L, Wohler A Diagnostics (Basel). 2024; 14(19).

PMID: 39410635 PMC: 11475707. DOI: 10.3390/diagnostics14192231.

Classification methods of pulmonary contusion based on chest CT and the association with in-hospital outcomes: a systematic review of literature.

Van Diepen M, Wijffels M, Verhofstad M, Van Lieshout E Eur J Trauma Emerg Surg. 2024; 50(6):2727-2740.

PMID: 39251438 PMC: 11666754. DOI: 10.1007/s00068-024-02666-w.

Diffuse alveolar hemorrhage in pediatrics: Etiologies and outcomes.

Cohen S, Eisner M, Fussner L, Krivchenia K Pediatr Pulmonol. 2024; 59(12):3364-3370.

PMID: 39115444 PMC: 11601033. DOI: 10.1002/ppul.27207.

Pulmonary Contusion-An Unusual Clinical and Radiological Presentation: Case Report.

Castrillon A, Sua L, Sanchez A, Fernandez-Trujillo L J Investig Med High Impact Case Rep. 2024; 12:23247096241266089.

PMID: 39051455 PMC: 11273703. DOI: 10.1177/23247096241266089.

References

Brower R, Matthay M, Morris A, Schoenfeld D, Thompson B, Wheeler A . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342(18):1301-8. DOI: 10.1056/NEJM200005043421801. View

RANSDELL Jr H . TREATMENT OF FLAIL CHEST INJURIES WITH A PISTON RESPIRATOR. J Trauma. 1965; 5:412-20. DOI: 10.1097/00005373-196505000-00013. View

Pepe P, Potkin R, Reus D, Hudson L, CARRICO C . Clinical predictors of the adult respiratory distress syndrome. Am J Surg. 1982; 144(1):124-30. DOI: 10.1016/0002-9610(82)90612-2. View

Richardson J, Franz J, Grover F, Trinkle J . Pulmonary contusion and hemorrhage--crystalloid versus colloid replacement. J Surg Res. 1974; 16(4):330-6. DOI: 10.1016/0022-4804(74)90051-1. View

Donnelly L, Klosterman L . Subpleural sparing: a CT finding of lung contusion in children. Radiology. 1997; 204(2):385-7. DOI: 10.1148/radiology.204.2.9240524. View

Weishaupt D, Hilfiker P, Schmidt M, Debatin J . Pulmonary hemorrhage: imaging with a new magnetic resonance blood pool agent in conjunction with breathheld three-dimensional magnetic resonance angiography. Cardiovasc Intervent Radiol. 1999; 22(4):321-5. DOI: 10.1007/s002709900396. View

Cohn S . Pulmonary contusion: review of the clinical entity. J Trauma. 1997; 42(5):973-9. DOI: 10.1097/00005373-199705000-00033. View

Falla S . Effect of Explosion-blast on the Lungs. Br Med J. 2010; 2(4155):255-6. PMC: 2178788. DOI: 10.1136/bmj.2.4155.255. View

GARZON A, SELTZER B, KARLSON K . Physiopathology of crushed chest injuries. Ann Surg. 1968; 168(1):128-36. PMC: 1387197. DOI: 10.1097/00000658-196807000-00015. View

10.

Bulger E, Edwards T, Klotz P, Jurkovich G . Epidural analgesia improves outcome after multiple rib fractures. Surgery. 2004; 136(2):426-30. DOI: 10.1016/j.surg.2004.05.019. View

11.

Rodrigues R, Miller P, Bozza F, Marchiori E, Zimmerman G, Hoffman J . FDG-PET in patients at risk for acute respiratory distress syndrome: a preliminary report. Intensive Care Med. 2008; 34(12):2273-8. DOI: 10.1007/s00134-008-1220-7. View

12.

Demling R, Niehaus G, Will J . Pulmonary microvascular response to hemorrhagic shock, resuscitation, and recovery. J Appl Physiol Respir Environ Exerc Physiol. 1979; 46(3):498-503. DOI: 10.1152/jappl.1979.46.3.498. View

13.

Zandstra D, Stoutenbeek C . Monitoring differential CO2 excretion during differential lung ventilation in asymmetric pulmonary contusion. Clinical implications. Intensive Care Med. 1988; 14(2):106-9. DOI: 10.1007/BF00257460. View

14.

Fulton R, PETER E . Compositional and histologic effects of fluid therapy following pulmonary contusion. J Trauma. 1974; 14(9):783-90. DOI: 10.1097/00005373-197409000-00008. View

15.

Michel R, Laforte M, Hogg J . Physiology and morphology of pulmonary microvascular injury with shock and reinfusion. J Appl Physiol Respir Environ Exerc Physiol. 1981; 50(6):1227-35. DOI: 10.1152/jappl.1981.50.6.1227. View

16.

Gayzik F, Martin R, Gabler H, Hoth J, Duma S, Meredith J . Characterization of crash-induced thoracic loading resulting in pulmonary contusion. J Trauma. 2009; 66(3):840-9. DOI: 10.1097/TA.0b013e318186251e. View

17.

Svennevig J, BUGGE-ASPERHEIM B, Bjorgo S, Kleppe H, Birkeland S . Methylprednisolone in the treatment of lung contusion following blunt chest trauma. Scand J Thorac Cardiovasc Surg. 1980; 14(3):301-5. DOI: 10.3109/14017438009101016. View

18.

Mizushima Y, Hiraide A, Shimazu T, Yoshioka T, Sugimoto H . Changes in contused lung volume and oxygenation in patients with pulmonary parenchymal injury after blunt chest trauma. Am J Emerg Med. 2000; 18(4):385-9. DOI: 10.1053/ajem.2000.7317. View

19.

Pape H, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H . Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma. 2000; 49(3):496-504. DOI: 10.1097/00005373-200009000-00018. View

20.

Balci A, Kazez A, Eren S, Ayan E, Ozalp K, Eren M . Blunt thoracic trauma in children: review of 137 cases. Eur J Cardiothorac Surg. 2004; 26(2):387-92. DOI: 10.1016/j.ejcts.2004.04.024. View