CONTUSIO PULMONUM

Background

• reported to be present up to 75 % of patient with

significant blunt chest trauma, high velocity missile wound
and the high energy shock waves of an explosion in air or
water
• defined as direct injury to the lung resulting in both
hemorrhage and edema in the absence of a pulmonary
laceration
 Patophysiology
• caused by an impact to the lung parenchyma followed by alveolar
edema amd hemorrhage but without an accompanying pulmonary
laceration. Develops over the course of 24 hours, leading to poor
gas exchange, increased pulmonary vascular resistance and
decreased lung compliance
• Fluid resuscitation in the setting of unilateral pulmonary contusion
can cause extravasation of fluid into the contralateral (uninjured)
lung. Increased capillary hydrostatic pressures result in leakage of
blood and fluid into the interstitium and alveoli
 Clinical features
• dyspnea
• tachypnea
• cyanosis
• tachycardia
• hypotension
• chest wall bruising
• rales and decreased breath sound
• could be reveal with rib fracture rib on palpation chest wall (
contusion pulmonum is commonly on flail chest
 Diagnostic test
• laboratory : hypoxemia, widening Aa DO2 (indicates a decreasing
pulmonary diffusion capacity and it is one of the earliest and most
accurate means of assessing the current status, progress, and
prognosis)
• Radiology : Chest CT scan and X ray can begin to appear within
minutes of injury and range from patchy, irregular, alveolar
infiltrate to frank consolidation found in nonsegmental areas of the
lung and across pleural fissures within 6hours after the injury. May
mimic those associated with aspiration pneumonia and fat
embolism, but these entities are typically not seen for 12 to 24
hours and usually have a segmental distribution
Chest radiograph shows pulmonary contusion
from blunt chest trauma, along with 9th and 10th rib
fractures
CT shows pulmonary contusions on the anterior part of the right
lung and a sternal fracture with mediastinal hematoma.
 Management
• primarily involves maintenance of adequate ventilation
and pain control
• restriction of intravenous (IV) fluids (to maintain
intravascular volume within strict limits) Fluid resuscitation
in the setting of unilateral pulmonary contusion can cause
extravasation of fluid into the contralateral (uninjured) lung
• vigorous tracheobronchial toilet, suctioning, and pain relief
 Mechanical ventilation
• The volume of contused lung influences the need for mechanical
ventilation. Patients with less than one fourth of total lung volume
involvement (about one lobe) usually do not require ventilatory
support. If ventilatory assistance is required, avoid overinflation of
normal alveoli
• Patients with severe unilateral lung injury who are not responding
to conventional mechanical ventilation may benefit from
synchronous independent lung ventilation provided through a
double-lumen endobronchial catheter. This technique helps
prevent overinflation of the normal lung and underinflation of the
damaged, poorly compliant lung.