Everything about Pulmonary Contusion totally explained
Pulmonary contusion is a
bruising (contusion) of the
lung which occurs as a result of
chest trauma. The injury causes bleeding into the tissue of the lung but isn't a
pulmonary laceration, which is a frank tear in the lung tissue. Contusion causes an accumulation of fluid (
edema) and blood in the
alveoli (the air sacs where gases are exchanged) and the
interstitial space of the lung. Pulmonary contusion may interfere with
gas exchange in the lungs and can therefore result in
hypoxia (inadequate oxygen levels),
pneumonia, or
acute respiratory distress syndrome. The severity can range from mild to potentially deadly.
Lung contusions, which may be caused by
blunt or
penetrating trauma, were first described during
World War II in people who had suffered
blast injuries. In civilians, the injury is most often due to
motor vehicle accidents. Pulmonary contusions rarely occur in isolation and are usually accompanied by other traumatic injuries. Signs and symptoms include indications that the body isn't receiving enough oxygen, such as
cyanosis, and direct effects of the physical trauma such as chest pain and coughing up blood. Clues from the injurious event,
physical examination and
chest radiography are used in the diagnosis of the injury. The most common serious injury to occur in association with
thoracic trauma, pulmonary contusion is found in 30–75% of severe cases of
chest injury and in 25–35% of all blunt chest trauma. Of people who have multiple injuries with an
injury severity score of over 15, pulmonary contusion occurs in about 17%.
Shortness of breath may also be associated with the injury. With severe contusions,
breath sounds may be decreased, or abnormal breath sounds called
rales may be present. Symptoms of severe contusions may occur by three or four hours after the injury. Thus, a person who has been injured with enough force to have suffered a pulmonary contusion is likely to have other types of injuries as well. when flail chest occurs, it's usually associated with pulmonary contusion. Pulmonary contusion may also be associated with injuries to the chest wall such as bruising Penetration by a rapidly moving
projectile is accompanied by a
shock wave capable of causing a contusion, which usually surrounds the path along which the projectile traveled through the tissue. After the shock wave passes, the gas in the lung may expand beyond its original volume and may tear alveoli; this is the implosion effect. The more bony chest walls of adults absorb the force themselves rather than transmitting it.
Pathophysiology
Bruising of the lung results in bleeding and fluid leakage into and edema of the lung tissues, which can become stiffened and lose their normal elasticity. As a result of these and other pathological processes that occur in the injury, the injury progresses over time and can cause
hypoxia or insufficient oxygen. The injury is progressive. Lung water increases over the first 72 hours after injury. In pulmonary contusions, damage to the capillary alveolar membrane and small blood vessels may cause blood and fluids to leak into the alveoli and
interstitial space. Over a period of hours after the injury, the alveoli in the injured area thicken and may become consolidated. can also cause parts of the lung to collapse.
Monocytes enter the area as part of the inflammatory process. The ratio of ventilation to perfusion is normally about one, but in pulmonary contusion, there isn't enough oxygen available to saturate the
hemoglobin, and the blood leaves the lung without being fully oxygenated: the ventilation/perfusion ratio is less than one. As the mismatch between ventilation and perfusion grows, blood
oxygen saturation is reduced. A classic sign of lung contusion is a "patchy infiltrate" seen on chest X-ray, Lung contusion may look similar in an X-ray to
aspiration, It takes an average of six hours for the opacification typical of pulmonary contusion to show up on a chest
X-ray, and the injury may not be apparent on a radiograph until 48 hours after the injury.
CT scanning is more sensitive to pulmonary contusion than chest X-ray is. Pulmonary hematomas, collections of blood within the lung parenchyma, are thought to develop in between 4 and 11% of pulmonary contusions. Treatment aims to prevent
respiratory failure; ensure that the sufferer receives adequate
oxygenation,
The administration of fluid therapy for pulmonary contusion is controversial. When the lesions are small, they normally don't increase the chances of death or poor outcome for people with blunt chest trauma; however, these chances increase with the size of the contusion. Thus children suffer double the number of pulmonary contusions as adults as a result of forceful impacts, yet have proportionately fewer rib fractures.
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