Using 99mTc-DTPA radioaerosol inhalation lung scan as compared with computed tomography to detect lung injury in blunt chest trauma

[Lung contusion after jumping from a 10 meter tower in a swimming pool]

BACKGROUND

Lung contusions often occur in the context of polytrauma, but much less frequently in sports injuries.

CASE DESCRIPTION

We report on a 22-year-old patient who presented to our emergency room. On the same day he jumped from a 10 meter tower in a swimming pool and hit the surface of the water with his thorax and abdomen. He complained of pain in the right chest and hemoptysis immediately after the jump.The examination findings remained without further abnormalities.In the chest x-ray no abnormalities were found.The CT thorax with contrast medium revealed homogeneous ground-glass opacities in the middle lobe and less in the ventrobasal upper lobe on the right, consistent with the pulmonary contusion with parenchymal bleeding. In addition, there was a minimal pneumothorax border on the paracardial right side.Bronchoscopy performed on the same day showed evidence of blood in the middle lobe bronchus.The hemoptysis stopped spontaneously. On the 3rd day of the hospital stay, the patient was discharged with stable vital parameters and asymptomatic.

CONCLUSION

Hemoptysis immediately after a sports chest injury may occur as a result of pulmonary contusion. In contrast to conventional chest x-rays, computed tomography is of great importance in the diagnosis of pulmonary contusion.

The epidemiological findings and characteristic ground glass appearance on chest CT among patients with blunt lung injury

AIM

To clarify the epidemiological findings and characteristics of ground glass lesions on chest computed tomography (CT) after blunt trauma.

SETTING AND DESIGN

A medical college hospital and retrospective study.

MATERIALS AND METHODS

We retrospectively investigated all blunt chest trauma patients who were admitted from January 2004 to December 2010. The inclusion criteria were patients with: (1) chest CT examination on arrival, (2) intrathoracic traumatic lesions confirmed by initial CT, and (3) a second chest CT examination within 7 days from admission. We divided the subjects into two groups. A GG group included subjects who had ground glass lesions on initial chest CT and a control group included subjects who did not have the ground glass appearance.

RESULTS

The average age in the GG group was significantly lesser than that in the control group. The ratio of improvement for the value of SpO(2)/FiO(2) between on arrival and the second hospital day and ratio of improvement for CT findings between on arrival and the second CT examination in the GG group was greater than in the control group.

CONCLUSION

The ground glass appearance on chest CT after blunt trauma was not rare, and the patients with ground glass lesions were younger and tended to have a better improvement of oxygenation and CT images in comparison with the patients without these characteristic lesions.

The value of pulmonary contusion volume measurement with three-dimensional computed tomography in predicting acute respiratory distress syndrome development

BACKGROUND

This study reports the value of accurate pulmonary contusion (PC) volume measurement with 3-dimensional computed tomography (CT) in predicting acute respiratory distress syndrome (ARDS) development.

METHODS

The study enrolled all patients who were diagnosed with PC on admission by CT and had a chest Abbreviated Injury Score (AIS) exceeding 2 between January 1, 2010, and October 31, 2010. PC volume was measured from 3-dimensional reconstructions of admission chest CTs and expressed as a percentage of total lung volume. Admission data were prospectively collected. The independent predictor of ARDS development was established. The accuracy and value of the predictors were analyzed, and the influence of PC volume percentage on clinical outcomes was demonstrated.

RESULTS

The average PC volume percentage was 21.86% ± 13.90% (range, 5.6% to 61.0%), which was inconsistently correlated with the admission partial pressure of oxygen/fraction of inspired oxygen ratio (R(2) = 0.083). ARDS was diagnosed in 26 patients (43.3%) and pneumonia in 21 (35.0%). The admission partial pressure of oxygen/fraction of inspired oxygen ratio (p = 0.003) and PC volume percentage (p = 0.01) were independent predictive factors of ARDS development. Patients with a PC volume percentage exceeding the best cutoff of 21.5% were defined as the severe PC group. The partial pressure of oxygen/fraction of inspired oxygen ratio, the needed maximal positive end-expiratory pressure level, and ARDS incidence between the severe group and the general group was significantly different (p <.05).

CONCLUSIONS

Pulmonary contusion volume measured using 3-dimensional CT is feasible in emergency departments and helpful to identify patients at high-risk for ARDS.

Pulmonary contusion: an update on recent advances in clinical management

Pulmonary contusion is a common finding after blunt chest trauma. The physiologic consequences of alveolar hemorrhage and pulmonary parenchymal destruction typically manifest themselves within hours of injury and usually resolve within approximately 7 days. Clinical symptoms, including respiratory distress with hypoxemia and hypercarbia, peak at about 72 h after injury. The timely diagnosis of pulmonary contusion requires a high degree of clinical suspicion when a patient presents with trauma caused by an appropriate mechanism of injury. The clinical diagnosis of acute parenchymal lung injury is usually confirmed by thoracic computed tomography, which is both highly sensitive in identifying pulmonary contusion and highly predictive of the need for subsequent mechanical ventilation. Management of pulmonary contusion is primarily supportive. Associated complications such as pneumonia, acute respiratory distress syndrome, and long-term pulmonary disability, however, are frequent sequelae of these injuries.