PULMONARY CONTUSION – Etiology, Pathophysiology, Signs and Symptoms, Diagnostic Evaluations, Prevention and Treatment
- Contusion is a 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 or hypoxia.
- Pulmonary contusion: it is usually caused directly by blunt trauma but can also result from explosion injuries or a shock wave associated with penetrating trauma
ETIOLOGY
- Motor vehicle accidents are the most common cause of pulmonary contusion
- Chest strikes the inside of the car
- Falls
- Assaults
- Sports injuries
- Explosions
PATHOPHYSIOLOGY
Pulmonary contusion (result in) —- bleeding and fluid leakage into lung tissue —- which can become stiffened and lose its normal elasticity —- the water content of the lung increases (leading to) —- frank pulmonary edema (cause) —- hypoxia
SIGNS AND SYMPTOMS
- Dyspnea (painful breathing or difficulty breathing)
- Rapid breathing
- Rapid heart rate
- Rales (an abnormal crackling sound in the chest accompanying breathing)
- Bronchorrhea (the production of watery sputum)
- Wheezing and coughing are other signs
- Coughing up blood or bloody sputum
- Cardiac output (the volume of blood pumped by the heart)
- Hypotension (low blood pressure)
- Tender or painful
DIAGNOSTIC EVALUATION
- X-ray: A chest X-ray showing right-sided pulmonary contusion associated with rib fractures and subcutaneous emphysema
- Computed tomography: a chest CT scan revealing pulmonary contusions, pneumothorax, and pseudocysts. Computed tomography (CT scanning) is a more sensitive test for pulmonary contusion, and it can identify abdominal chest, or other injuries that accompany the contusion. CT scans also help differentiate between contusion and pulmonary hematoma
- Ultrasound: an ultrasound image showing early pulmonary contusion, at this moment not visible on radiography
PREVENTION
- Airbags in combination with seat belts can protect vehicle occupants by preventing the chest from striking the interior of the vehicle during an collision
- Child restraints such as car seats protect children in vehicle collisions from pulmonary contusion
- Equipment exists for use in some sports to prevent chest and lung injury, for example, in softball, the catcher is equipped with a chest
- Protective garments can also prevent pulmonary contusion in explosions
TREATMENT
- Ventilation: mechanical ventilation may be required if pulmonary contusion causes inadequate oxygenation
- Fluid therapy: the administration of fluid therapy in individuals with pulmonary contusion is controversial. Excessive fluid in the circulatory system (hypervolemia) can worsen hypoxia because it can cause fluid leakage from injured capillaries (pulmonary edema) which are more permeable than normal
- Supportive care: the use of suction, deep breathing, coughing, and other methods to remove material, such as mucus and blood from the airways. Chest physical therapy makes use of techniques, such as breathing exercises, stimulation of coughing, suctioning, percussion, movement, vibration and drainage to rid the lungs of secretions, increase oxygenation and expand collapsed parts of the lungs
COMPLICATIONS
- Pneumonia
- Acute respiratory distress syndrome
- Pulmonary edema
- Pneumonia
