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Post-traumatic pulmonary contusion in children
1Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee 53201.
Insights
Pediatric pulmonary contusion, often from motor vehicle accidents, typically presents without obvious chest trauma signs. Early chest X-rays are crucial for detecting associated injuries and guiding management.
Area of Science:
- Pediatric Traumatology
- Thoracic Imaging
- Pulmonary Medicine
Background:
- Post-traumatic pulmonary contusion is a significant injury in children.
- Often associated with high-impact events like motor vehicle accidents and multiple trauma.
- Clinical presentation can be misleading, with frequent absence of typical physical findings.
Purpose of the Study:
- To review cases of pediatric pulmonary contusion.
- To analyze associated injuries, clinical presentation, and radiographic findings.
- To determine the prognosis and recommend management strategies.
Main Methods:
- Retrospective review of 35 pediatric cases of pulmonary contusion over 12 years.
- Analysis of patient demographics, trauma mechanisms, clinical signs, and radiographic data.
- Correlation of bony thorax fractures with associated intrathoracic lesions.
Main Results:
- Most cases (86%) involved motor vehicle accidents, and 83% had multiple trauma.
- Typical physical findings (tachypnea, hemoptysis) were often absent.
- Associated intrathoracic lesions (pleural effusion, pneumothorax, hemothorax) occurred in 57%, especially with bony thorax fractures (93%).
- Radiographic evidence of contusion was present on admission in 97% and did not progress.
- No patients required mechanical ventilation; prognosis was good.
Conclusions:
- Pediatric pulmonary contusion, usually from significant trauma, has a favorable prognosis.
- Chest radiography is essential for children with high-impact trauma, even with minimal physical findings.
- Serial chest imaging is recommended for 48 hours in cases with associated bony thorax fractures.
Abstract:
We reviewed 35 consecutive cases of post-traumatic pulmonary contusion in children that occurred during a 12-year period. Of these, 19 children (54%) were more than 5 years old, 30 (86%) were involved in motor vehicle accidents, and 29 (83%) had multiple trauma. External thoracic wall contusion, fracture of the bony thorax, tachypnea, hemoptysis, and abnormal breath sounds were frequently absent on presentation. Associated intrathoracic lesions of pleural effusion, pneumothorax, and hemothorax occurred in 20 children (57%) and were particularly prevalent in those with fracture of the bony thorax (93%); the radiographic appearance of these lesions was delayed up to 48 hours in 40% of cases. In 34 children (97%), radiographic evidence of pulmonary contusion was present on admission and did not progress radiographically during hospitalization. No child experienced respiratory deterioration subsequent to presentation or required mechanical ventilation for respiratory insufficiency. Pulmonary contusion in children is usually a consequence of significant-impact injury associated with multiple trauma and has a good prognosis. Despite a paucity of abnormal physical findings, children who sustain high-impact trauma should receive radiographic evaluation of the chest to assess for possible intrathoracic injury. When pulmonary contusion is accompanied by fracture of the bony thorax, serial radiographic evaluation of the chest should be performed during the initial 48 hours of hospitalization.