Pulmonary contusion in the pan-scan era

Area of Science:

• Trauma Surgery
• Diagnostic Imaging
• Thoracic Medicine

Background:

• Pulmonary contusion (PC) is traditionally viewed as a severe injury requiring intensive monitoring.
• Increased use of chest CT in blunt trauma evaluation may lead to the diagnosis of clinically insignificant PC.

Purpose of the Study:

• To compare the frequency of PC diagnosis by chest CT versus chest X-ray (CXR).
• To determine the frequency of PC-associated thoracic injuries.
• To evaluate clinical outcomes (mortality, length of stay, mechanical ventilation) for PC patients, particularly those with PC seen on CT only (SOCTO) and isolated PC.

Main Methods:

• Analysis of prospectively enrolled blunt trauma patients (age >14) presenting within 24 hours.
• Inclusion of patients who underwent both CXR and chest CT.
• Definition of PC and thoracic injuries based on CT reports, with follow-up for clinical outcomes.

Main Results:

• PC was diagnosed in 11.7% of patients with both CXR and CT, making it the second most common injury.
• Pulmonary contusion was seen on CT only (SOCTO) in 73.0% of cases.
• While PC patients had higher admission rates and mortality, outcomes were comparable to non-PC patients when PC was isolated or SOCTO, with low rates of mechanical ventilation (4.6%) and mortality (2.6%).

Conclusions:

• Pulmonary contusion is commonly diagnosed with current imaging protocols, often SOCTO with other thoracic injuries.
• Isolated PC and PC SOCTO appear to have limited clinical significance due to low mortality and infrequent need for mechanical ventilation.