April 4, 2013

Traumatology: Left lung contusion

24 years old male involve in low speed injury involving motorcycle vs. tractor. Patient is a motorcycle driver, wearing helmet that crashed into a moving tractor at a speed of less than 60 km/h at the corner and fall under the tractor.  He however denied any roll over, loss of consciousness and sign and symptoms of increase intracranial pressure.

The chest X rays shows 1) left lung heterogeneous opacities involving lower and middle zone which is suggestive of Lung Contusion, no hemo/pneumothorax and trachea is centrally located. 2) Left 6th rib fracture, 3) Right inferior scapula simple fracture, and 4) left inferior scapula comminuted fracture.

Lung/Pulmonary contusion is an injury that occurs when there is a disruption of pulmonary tissue architecture, disruption of alveolar membrane with bleeding and edema into the alveolar space (Shirley ooi). It is due to blunt and penetrating trauma, blast injury and compressive injury.

Patient may presented with respiratory distress, reduce breath sound over affected lung, crepitation and hypoxemia.

Apart from this injury, patient also sustains left proximal femur closed fracture with displacement and multiple abrasion wounds over left hand, and left posterior shoulder. However, he is asymptomatic of lung contusion, SPO2 under room air is 100% and ABG only shows mild hypoxemia.

This is an example of polytrauma with possible mechanism of injury of the collision occurs side of motorcycle to the front of tractor. This results the patient to fall under the tractor. Even though the speed is slow, but this case is definitely a high impact injury in view of long bone fracture. The message is, this patient may die if we only rely on the CXR and sent the patient home. Second message, look for any associate injury if you see this CXR in trauma patient.

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