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Case 35 - Pulmonary contusion and laceration

from Section 3 - Thorax

Published online by Cambridge University Press:  05 March 2013

By
Randy K. Lau
Edited by
Martin L. Gunn
Martin L. Gunn
Affiliation:
University of Washington School of Medicine
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Summary

Imaging description

Pulmonary contusions, aspiration, and pneumonia have overlapping imaging appearances, and can be difficult to distinguish in the acutely injured patient. However, both the imaging and appearance and time course can assist in discriminating between these entities. On radiographs, contusions appear as geographic areas of air-space opacification, and are usually located adjacent to bony structures and hence are peripherally located [1].

Pulmonary contusions may not be evident on initial radiographs but may appear on chest radiographs acquired up to 6 hours after injury. Development of pulmonary opacities 24 hours or more after injury suggests nosocomial pneumonia, atelectasis, or aspiration. However, caution is still warranted. Series have shown that the appearance of a pulmonary opacity has a specificity of only 27–35% for pneumonia in a patient on mechanical ventilation [2]. Specific signs that suggest ventilator-associated pneumonia (VAP) include rapid or progressive cavitation of the pulmonary opacity, an airspace process abutting a fissure, and an air bronchogram [2].

Type
Chapter
Information
Pearls and Pitfalls in Emergency Radiology
Variants and Other Difficult Diagnoses
 , pp. 118 - 120
Publisher: Cambridge University Press
Print publication year: 2013

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References

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