Pulmonary Contusion

Description

Transfer of kinetic energy to the lung, causing direct damage to the lung parenchyma, resulting in both hemorrhage and edema in the absence of a pulmonary laceration:

• Mortality rate is 10–25%
• Most common lung injury in blunt trauma cases
• Independent risk factor for:
  • Acute respiratory distress syndrome (ARDS)
  • Pneumonia
  • Long-term respiratory dysfunction

Pathophysiology

• Development of pulmonary contusion (PC):
  • Takes place in 2 stages:
    • 1st stage: Related to the direct injury resulting in alveolar hemorrhage and edema
    • 2nd stage: Related to the indirect worsening of the injury as a result of measures that occur during the resuscitation of the patient, in particular, administration of IV fluids
• Leads to:
  • Decreased lung compliance
  • Increased alveolar capillary permeability
  • Increased intrapulmonary shunting
  • Acute local and systemic inflammation
  • Hypoxemia, hypercarbia, acidosis
  • Increased respiratory work
  • Respiratory failure/ARDS

Etiology

• Blunt or penetrating thoracic trauma
• Sudden deceleration–compression
• Fall from height
• Motor vehicle accident
• Assault
• Blast injuries and explosions
• Contact sports