Silent Lung Injury: Acute Respiratory Distress Syndrome without Chest Trauma Following a High-Level Fall

Acute respiratory distress syndrome (ARDS) is a life-threatening form of non-cardiogenic respiratory failure that can occur after severe systemic or traumatic insults. We report a rare case of ARDS in a 17-year-old female who sustained a burst fracture at the second lumbar vertebra and bilateral calcaneal fractures after jumping from a height of six meters. She underwent uneventful spinal decompression and instrumentation six hours post-injury, with stable hemodynamics and balanced fluid administration. Initial chest CT showed no lung abnormalities. On postoperative day 2, she developed respiratory distress preceded by a metallic, blood-like taste during breathing. Follow-up CT revealed new bilateral diffuse lung consolidations. Bronchoscopy showed diffuse pulmonary hemorrhage without active bleeding, suggesting lung contusion. Echocardiography excluded cardiac causes, and extensive microbiological testing, including bronchoalveolar lavage and viral panels, yielded no infectious pathogens. Although broad-spectrum antibiotics were used in response to perioperative fever and elevated inflammatory level, no definitive infection was identified, and inflammatory markers normalized with ventilatory support. This case illustrates a potential underrecognized mechanism of ARDS: pulmonary contusion from high-energy vertical deceleration in the absence of external chest trauma. To our knowledge, no prior literature has reported ARDS following spinal fractures due to vertical falls without chest wall injury. We propose that sudden deceleration during impact can transmit force through the thoracic cage, causing occult microvascular lung injury. Early recognition and close respiratory monitoring are essential in similar trauma scenarios, even when initial imaging is unremarkable.