UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Pulmonary contusion in children

Author
Alison Chantal Caviness, MD, MPH, PhD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

This topic will discuss the epidemiology, clinical features, and management of pulmonary contusion in children. The approach to thoracic trauma in children and other thoracic injuries are presented elsewhere. (See "Initial evaluation and stabilization of children with thoracic trauma" and "Chest wall injuries in children" and "Overview of intrathoracic injuries in children".)

DEFINITION

Pulmonary contusion is defined as pulmonary parenchymal damage with edema and hemorrhage, in the absence of an associated pulmonary laceration.

EPIDEMIOLOGY

Thoracic injury in children is uncommon, occurring in 4 to 8 percent of injured children identified through trauma registries or as patients at trauma centers [1-3]. Of those with thoracic injury, most have a pulmonary contusion.

The vast majority of pulmonary contusions are the result of blunt trauma, usually involving a motor vehicle. In one retrospective series, 56 percent of injuries occurred in a motor vehicle crash, while 39 percent were the result of auto-pedestrian collisions [4].

Associated thoracic injuries (ie, pleural effusion, pneumothorax, hemothorax, and fractures of the bony thorax) occur in the majority of patients [4,5]. Flail chest and scapular fractures are uncommon in children, but they are almost always associated with pulmonary contusion. (See "Chest wall injuries in children".)

          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Oct 06 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Cooper A, Barlow B, DiScala C, String D. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg 1994; 29:33.
  2. Peclet MH, Newman KD, Eichelberger MR, et al. Thoracic trauma in children: an indicator of increased mortality. J Pediatr Surg 1990; 25:961.
  3. Holmes JF, Sokolove PE, Brant WE, Kuppermann N. A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med 2002; 39:492.
  4. Allen GS, Cox CS Jr, Moore FA, et al. Pulmonary contusion: are children different? J Am Coll Surg 1997; 185:229.
  5. Bonadio WA, Hellmich T. Post-traumatic pulmonary contusion in children. Ann Emerg Med 1989; 18:1050.
  6. Fung YC, Yen RT, Tao ZL, Liu SQ. A hypothesis on the mechanism of trauma of lung tissue subjected to impact load. J Biomech Eng 1988; 110:50.
  7. Ruddy RM. Trauma and the paediatric lung. Paediatr Respir Rev 2005; 6:61.
  8. Gittelman MA, Gonzalez-del-Rey J, Brody AS, DiGiulio GA. Clinical predictors for the selective use of chest radiographs in pediatric blunt trauma evaluations. J Trauma 2003; 55:670.
  9. Kwon A, Sorrells DL Jr, Kurkchubasche AG, et al. Isolated computed tomography diagnosis of pulmonary contusion does not correlate with increased morbidity. J Pediatr Surg 2006; 41:78.
  10. Donnelly LF, Klosterman LA. Subpleural sparing: a CT finding of lung contusion in children. Radiology 1997; 204:385.
  11. Hamrick MC, Duhn RD, Carney DE, et al. Pulmonary contusion in the pediatric population. Am Surg 2010; 76:721.
  12. Allen GS, Cox CS Jr. Pulmonary contusion in children: diagnosis and management. South Med J 1998; 91:1099.
  13. Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med 2002; 30:S409.
  14. Cullen ML. Pulmonary and respiratory complications of pediatric trauma. Respir Care Clin N Am 2001; 7:59.
  15. Johannigman JA, Campbell RS, Davis K Jr, Hurst JM. Combined differential lung ventilation and inhaled nitric oxide therapy in the management of unilateral pulmonary contusion. J Trauma 1997; 42:108.
  16. Fioretto JR, de Moraes MA, Bonatto RC, et al. Acute and sustained effects of early administration of inhaled nitric oxide to children with acute respiratory distress syndrome. Pediatr Crit Care Med 2004; 5:469.
  17. Taylor RW, Zimmerman JL, Dellinger RP, et al. Low-dose inhaled nitric oxide in patients with acute lung injury: a randomized controlled trial. JAMA 2004; 291:1603.
  18. Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma 1988; 28:298.
  19. Davis SL, Furman DP, Costarino AT Jr. Adult respiratory distress syndrome in children: associated disease, clinical course, and predictors of death. J Pediatr 1993; 123:35.
  20. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000; 342:1334.
  21. Haxhija EQ, Nöres H, Schober P, Höllwarth ME. Lung contusion-lacerations after blunt thoracic trauma in children. Pediatr Surg Int 2004; 20:412.
  22. Kishikawa M, Yoshioka T, Shimazu T, et al. Pulmonary contusion causes long-term respiratory dysfunction with decreased functional residual capacity. J Trauma 1991; 31:1203.
  23. Orliaguet G, Rakotoniaina S, Meyer P, et al. [Effect of a lung contusion on the prognosis of severe head injury in the child]. Ann Fr Anesth Reanim 2000; 19:164.
  24. Leone M, Albanèse J, Rousseau S, et al. Pulmonary contusion in severe head trauma patients: impact on gas exchange and outcome. Chest 2003; 124:2261.