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* This is the Professional Version. *

Pulmonary Contusion

By Thomas G. Weiser, MD, MPH, Department of Surgery, Section of Trauma & Critical Care, Stanford University School of Medicine

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Patient Education

Pulmonary contusion is trauma-induced lung hemorrhage and edema without laceration.

Pulmonary contusion is a common and potentially lethal chest injury that results from significant blunt or penetrating chest trauma. Patients may have associated rib fracture, pneumothorax, or other chest injuries. Larger contusions can impair oxygenation. Late complications include pneumonia and sometimes acute respiratory distress syndrome (ARDS).

Symptoms include pain (mainly due to injury to the overlying chest wall) and sometimes dyspnea. The chest wall is tender; other physical findings are those of any associated injuries.

Diagnosis

  • Imaging, typically chest x-ray

The diagnosis should be suspected when respiratory distress develops after chest trauma, particularly when symptoms worsen gradually. Chest x-ray is typically done, along with pulse oximetry. Contusions cause opacification of affected lung tissue on imaging, but opacification may not be apparent for 24 to 48 h because opacification increases with time. CT is highly sensitive but is usually done only when other injuries are also under consideration.

Patients should be monitored for respiratory failure with serial clinical assessments and pulse oximetry. If hypoxemia or dyspnea is noted, capnometry or ABG measurement is  indicated.

Treatment

  • Supportive care with analgesics and O2

  • Sometimes mechanical ventilation

Analgesics are given as needed to facilitate deep respirations. Supplemental O2 is given for mild hypoxemia (Sao2 91 to 94%). Usual indications for mechanical ventilation are moderate or severe hypoxemia (usually Pao2 < 65 or Sao2 < 90% while breathing room air) and hypercarbia. Patients with COPD or chronic kidney disease are at increased risk of the need for mechanical ventilation.

* This is the Professional Version. *