![]() In these early reports, the occurrence of serious lung injury in the absence of associated bony trauma was attributed to the elasticity of the chest wall of younger patients. The first description of pulmonary trauma without associated chest wall injury has been attributed to Morgagni in 1761 the initial commentary in the English medical literature was written by R. The initial reports of pulmonary contusion focused on the description of severe lung injury with an “intact thorax”. Patients who have experienced trauma involving high-energy transfer should be evaluated for pulmonary contusion because prompt diagnosis and intervention may improve outcome. Although for children the mechanism of injury differs from that for adults and generally involves being struck by a motor vehicle as a pedestrian, the outcomes of pulmonary contusions appear to be similar for both age groups. Patients who sustain pulmonary contusions are at a higher risk than other trauma patients of subsequent adverse events, including pneumonia and acute respiratory distress syndrome (ARDS), and long-term respiratory disability may result. The clinical manifestations of lung injuries may be insidious respiratory difficulty and radiographic findings may become evident hours after injury. In the combat setting, the shock wave produced by explosions and high-velocity projectiles may cause serious trauma to the pulmonary parenchyma. Near-side lateral impact during a vehicular crash has also been implicated as an important mechanism leading to this lesion. Recent reports from the Crash Injury Research and Engineering Network (CIREN) demonstrated that two significant predictors of pulmonary contusion are an instantaneous change in velocity (delta V) of more than 45 mph (odds ratio = 1.9) and a frontal crash into a fixed object (OR = 1.8). Īmong civilian trauma populations, falls and rapid deceleration after vehicular crashes are the predominant mechanisms of lung injury. Although thoracic injuries among children are uncommon, 50% of such lesions involve pulmonary contusion. A review of data from the Trauma Registry at University Hospital in San Antonio, TX indicated that 1722 (27%) of 6332 patients with multiple traumatic injuries and an Injury Severity Score (ISS) of 15 or higher had pulmonary contusions. Pulmonary contusion is a common result of major trauma. Associated complications such as pneumonia, acute respiratory distress syndrome, and long-term pulmonary disability, however, are frequent sequelae of these injuries. Management of pulmonary contusion is primarily supportive. 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. 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. Clinical symptoms, including respiratory distress with hypoxemia and hypercarbia, peak at about 72 h after injury. The physiologic consequences of alveolar hemorrhage and pulmonary parenchymal destruction typically manifest themselves within hours of injury and usually resolve within approximately 7 days. Pulmonary contusion is a common finding after blunt chest trauma.
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