What are the typical CT thorax findings of a lung contusion and how should it be managed?

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Lung Contusion: CT Thorax Findings and Management

Typical CT Thorax Findings

Lung contusion appears on CT thorax as patchy areas of ground-glass opacity or consolidation that do not conform to anatomic boundaries (lobar or segmental), typically appearing within hours of blunt chest trauma and reaching maximum extent within 24 hours. 1, 2, 3

Primary Imaging Characteristics

  • Ground-glass opacities (GGO) represent areas of hazy increased lung attenuation with preservation of bronchial and vascular margins, caused by alveolar hemorrhage and interstitial fluid accumulation 4, 1

  • Consolidation patterns may develop when alveolar hemorrhage is more severe, with obscuration of underlying bronchovascular structures 4, 5

  • Non-anatomic distribution is characteristic—contusions do not respect lobar or segmental boundaries and appear as patchy, irregular opacities scattered throughout the affected lung regions 1, 2

  • Peripheral or pleural-based location is common, particularly at sites of direct chest wall impact 2, 3

Diagnostic Sensitivity and Timing

  • CT chest is highly sensitive for diagnosing pulmonary contusion and significantly more sensitive than chest radiography, which may initially appear normal or underestimate the extent of injury 2, 3

  • Findings evolve rapidly—contusions typically manifest within the first few hours after trauma, reach maximum extent by 24 hours, and usually resolve within 7 days 1, 2, 3

  • CT can predict clinical course—the extent of contusion on CT correlates with the need for mechanical ventilation and risk of complications 2, 3

Important Distinguishing Features

  • Absence of lung sliding on ultrasound can occur with lung contusion (as well as pneumothorax, atelectasis, or consolidation), so this finding alone does not indicate pneumothorax 6

  • Heterogeneous lung attenuation from contusion must be distinguished from other causes including varying regional perfusion, airway disease with air trapping, or infectious/inflammatory GGO 5

  • Vessel caliber assessment helps differentiate contusion (normal vessel caliber within GGO) from primary vascular disease (decreased vessel caliber in affected areas) 4, 5

Clinical Management

Supportive Care Framework

Management of lung contusion is primarily supportive, focusing on maintaining adequate oxygenation and preventing complications, as there is no specific therapeutic intervention that reverses the underlying alveolar hemorrhage and parenchymal injury. 1, 2, 3

Respiratory Support

  • Supplemental oxygen should be provided to maintain adequate oxygenation, as hypoxemia results from ventilation/perfusion mismatch and increased intrapulmonary shunting 1, 2

  • Mechanical ventilation is indicated when respiratory distress, hypoxemia, or hypercarbia cannot be managed with supplemental oxygen alone—CT findings can help predict which patients will require this intervention 2, 3

  • Peak respiratory symptoms typically occur at approximately 72 hours post-injury, when hypoxemia and hypercarbia are greatest 2, 3

Monitoring and Complications

  • Pneumonia is a frequent complication requiring vigilant monitoring and appropriate antibiotic therapy when diagnosed 2, 3

  • Acute respiratory distress syndrome (ARDS) can develop as a sequela of severe contusion and requires intensive supportive care 2, 3

  • Long-term pulmonary disability may occur in patients with severe contusions or those who develop ARDS 2, 3

Clinical Course Expectations

  • Resolution timeline—most contusions resolve within approximately 7 days, with alveolar hemorrhage and parenchymal destruction maximal in the first 24 hours 1, 2, 3

  • Clinical symptoms including respiratory distress peak around 72 hours after injury, then gradually improve if complications do not develop 2, 3

Critical Diagnostic Considerations

  • High clinical suspicion is essential when evaluating patients with appropriate mechanism of injury (blunt chest trauma), as early diagnosis allows for timely supportive intervention 2

  • CT chest with IV contrast is the reference standard for evaluating thoracic trauma and can identify associated injuries such as hemothorax, pneumothorax, rib fractures, and vascular injuries 6

  • Pulmonary contusion occurs in 25-35% of all blunt chest trauma cases, making it a common finding that should be actively sought on imaging 1

References

3
Research

Pulmonary contusion: review of the clinical entity.

The Journal of trauma, 1997

6
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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