PNEUMOTHORAX ,PULMONARY CONTUSION

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PNEUMOTHORAX ,PULMONARY CONTUSION

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Authored By: dalia yosif, Radiologist, Kasr Aini hospital, Egypt.

Patient: 28 year old male

History: 28 year old male: ,following MVA

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Findings:

Topogram shows :evidence of right sided pneumothorax with (pleural line)

at the axial cuts of the CAT scan :

right sided pneumothorax,bilateral lung contusion(evidenced by veiling of both upper & posterior lung fields),also endotracheal tube is seen insitu.

Diagnosis: Right sided pneumothorax ,Pulmonary contusion

Discussion:

Pulmonary contusion and laceration are injuries to the lung tissue;A lung contusion represents a bruise of the lung,A lung contusion is usually a combination of alveolar hemorrhage with interstitial hemorrhage and edema. Most patients have minimal respiratory deficit�as a result of�the injury. Extensive contusions may result in respiratory difficulty or progress to acute respiratory distress syndrome.

CAUSES OF PULMONARY CONTUSION :

1-It�is usually caused by blunt trauma. Following blunt trauma, such as that produced by a deceleration or blast injury, a pressure wave compresses the thoracic cavity, injuring the underlying lung. In the young, the pliable thoracic wall usually returns to its initial state, and no rib fracture may occur despite underlying lung injury. In older individuals, rib fractures with underlying lung contusion are common.

2-penetrating trauma can cause pulmonary contusion Contusion resulting from penetration by a rapidly moving projectile usually surrounds the path along which the projectile traveled through the tissue.The pressure wave forces tissue out of the way, creating a temporary cavity; the tissue readily moves back into place, but it is hurt. Pulmonary contusions that accompany gun and knife wounds are not usually severe enough to have a major effect on outcome; penetrating trauma causes less widespread lung damage than does blunt trauma. An exception is shotgun wounds, which can seriously damage large areas of lung tissue through a blast injury mechanism.

DIAGNOSIS OF PULMONARY CONTUSION:

X RAY

Chest X-ray is the most common method used for diagnosis, and may be used to confirm a diagnosis already made using clinical signs. Consolidated areas appear white on an X-ray film.Contusion is not typically restricted by the anatomical boundaries of the lobes or segments of the lung, and the presence of hemothorax or pneumothorax may obscure the contusion on a radiograph

Computed tomography (CT scanning) is a more sensitive test for pulmonary contusion, CT scanning also helps determine the size of a contusion, which is useful in determining whether a patient needs mechanical ventilation; a larger volume of contused lung on CT scan is associated with an increased likelihood that ventilation will be needed�

References: Wikipedia & emedicine

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