Pulmonary contusion

Q: Pulmonary contusions evident on CT scan but not on plain chest X-ray (CXR) have better outcomes? (select one)

A) True

B) False

Answer: A

Pulmonary contusion is one of the most deceiving clinical pictures in blunt chest trauma. It can be easily missed on initial evaluation as it gradually develops over the first 24 hours. It usually resolves in about a week. It is characteristically present as irregular, nonlobular opacification of the lung parenchyma. Unfortunately, it may not be apparent on CXR, and may require a CT scan of chest to better diagnose it. Some experts argue about its utility as non-evident CXR is usually benign and requires only clinical followup. Addition of CT scan mostly does not alter clinical management. Pain control and pulmonary toilet are usually sufficed.

#trauma

References:

1. Wanek S, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin 2004; 20:71.

2. Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg 1982; 196:481.

3. Deunk J, Poels TC, Brink M, et al. The clinical outcome of occult pulmonary contusion on multidetector-row computed tomography in blunt trauma patients. J Trauma 2010; 68:387.