Pulmonary contusion overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A pulmonary contusion (or lung contusion) is a contusion (bruise) of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, potentially leading to inadequate oxygen levels (hypoxia). Unlike pulmonary laceration, another type of lung injury, pulmonary contusion does not involve a cut or tear of the lung tissue.

Pathophysiology

A pulmonary contusion usually is caused by blunt trauma but also is caused by explosions or a shock wave associated with penetrating trauma. With the use of explosives during World Wars I and II, pulmonary contusion resulting from blasts gained recognition. In the 1960s its occurrence began to receive wider recognition in civilians, for whom it is usually caused by traffic accidents. The use of seat belts and airbags reduces the risk to vehicle occupants.

Treatment

Medical Therapy

No treatment is known to speed the healing of a pulmonary contusion; the main care is supportive. Attempts are made to discover injuries accompanying the contusion, to prevent additional injury, and to provide supportive care while waiting for the contusion to heal. Monitoring, including keeping track of fluid balance, respiratory function, and oxygen saturation using pulse oximetry is also required as the patient's condition may progressively worsen.[1] Monitoring for complications such as pneumonia and acute respiratory distress syndrome is of critical importance.[2] Treatment aims to prevent respiratory failure and to ensure adequate blood oxygenation. Supplemental oxygen can be given and it may be warmed and humidified. When the contusion does not respond to other treatments, extracorporeal membranous oxygenation may be used, pumping blood from the body into a machine that oxygenates it and removes carbon dioxide prior to pumping it back in.

References

  1. Ridley SC (1998). "Surgery for adults". In Pryor JA, Webber BR. Physiotherapy for Respiratory and Cardiac Problems. Edinburgh: Churchill Livingstone. p. 316. ISBN 0-443-05841-5.
  2. Ruddy RM (2005). "Trauma and the paediatric lung". Paediatric Respiratory Reviews. 6 (1): 61–67. doi:10.1016/j.prrv.2004.11.006. PMID 15698818. Unknown parameter |month= ignored (help)

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