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October 14, 1974

Pulmonary Contusion

JAMA. 1974;230(2):264. doi:10.1001/jama.1974.03240020054026

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Pulmonary contusion is a life-threatening condition, mainly because the onset of symptoms is insidious. Also, since the force required to produce lung contusion must be great, the lesion is likely to occur principally in cases of highspeed accidents, falls from great heights, and injuries by high-velocity bullets. Patients suffering such accidents often have so many other obvious injuries that a chest lesion may escape consideration.

When the symptoms of pulmonary contusion become obvious, the patient has dyspnea, tachypnea, cyanosis, tachycardia, and hypotension. At that time, a previously overlooked chest bruise may be noticed, and palpation may disclose fractures of the ribs or sternum. Moist rales or absent breath sounds may be present at the site of the injury. Arterial blood gas analysis usually shows hypoxemia, often out of proportion to the extent of opacities in the chest roentgenogram, which may show patchy, irregular, ill-defined densities or homogeneous consolidations or both.